Deformities of the Thoracic Wall: Don't Forget the Plastic Surgeon

Abstract

Surgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair of pectus excavatum or similar interventions (modified open videoendoscopically assisted repair of pectus excavatum), for remodeling the anterior thoracic wall may finally not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric and polymorphic cases, remnant deformities may still be present after any sophisticated remodeling attempt. On the other hand, some cases despite optimal surgical management develop mild recurrences with partial concavity or rib cartilage distortion shortly after pectus-bar removal. Secondary treatment options then may include open access surgery, resection, or reshaping of deformed and prominent costal cartilage. Residual concave areas can be filled by autologous tissue, such as cartilage chips, liposhifting, or implantation of customized alloplastics. To provide the best options for a variety of primary or secondary postsurgical expressions of anterior wall deformities, any physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques or at least should have knowledge of such. However, among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. Careful selection of appropriate techniques, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be mandatory, based on the heterogeneity of symptoms, severity, expectations, and surgical and technical resources. A variety of such ancillary reconstructive procedures for PE repair are explained and illustrated herewith.

The changes of distance between nipples following correction of women pectus excavatum

“…In this study, the authors have performed needlescope-assisted three-point fixation 18 , with or without quadrangular fixation 19 of the pectus bars which was a technique invented to avoid bar displacement, a common and serious complication of the Nuss procedure. Schwabegger et al named the symptom that normally developed breasts in puberty 20 were slanting medially along the slope of distorted ribs in women pectus excavatum patients as breast strabismus [21][22][23] . These breast deformities like breast strabismus cause emotional distress in female pectus excuvatum patients, even though a functional issue with breast strabismus has not been known.…”

Coronal, Sagittal, and Horizontal Classification of the Chest Shape and Its Role in Selection of Proper Implants

“…Assessing chest deformity is essential not only for planning standard breast surgery or chest wall corrections 8,9 and breast corrections like in Poland syndrome 10 but also for comparing postoperative outcomes. Tissue expansion, 11 capsular contracture, preoperative radiotherapy, 12 and delayed reconstruction 13 have all been identified as potential risk factors for chest wall deformities.…”

The changes of distance between nipples following correction of women pectus excavatum

“…Schwabegger et al named the symptom that normally developed breasts in puberty 20 were slanting medially along the slope of distorted ribs in women pectus excavatum patients as breast strabismus [21][22][23] . By remodeling the anterior thoracic wall with Nuss procedure, the slaning breasts were relocated to their orthotopic position, resulting in a more naturally breast projection 23 .…”