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Pectus excavatum is a common congenital thoracic deformity that occurs in about 1:500 births. Males are more frequently affected than females. In severe cases it may be associated with pulmonary impairment but many pectus excavatum cases are cosmetic deformities. Given the importance of the appearance of the male chest it is no surprise that such thoracic deformities carry with them a significant psychological impact.

The most common surgical technique for the treatment of pectus excavatum are invasive and range from the historic radical cartilage resection to the contemporary Nuss procedure. While invasive the use of the Nuss bar does not remove rib cartilages and uses a metal bar to reshape the chest internally. But the bar does need to be removed secondarily and the degree of correction can often be incomplete. Better results are in the youngest patients where the rib cartilages are most malleable.

In the May 2016 issue of the journal Plastic and Reconstructive Surgery, an article  was published ‘Correction of Pectus Excavatum by Custom-Made Silicone Implants: Contribution of Computer-Aided Design Reconstruction. A 20-Year Experience and 401 Cases.’  In this paper, the authors report on their experience with a large number of silicone implants to treat funnel chests. Prior to 2007, implants were made from plaster chest molds. Since 2007 three-dimensional reconstructions were made from CT scans by computer-aided design. Only one infection and three hemtomas occurred. All implants developed some degree of periprosthetic seroma. Patients rated the appearance of computer-designed implants as much better than that of the plaster molds. The degree of correction of the chest deformity was also better corrected with  the computer-designed implants. A Medical Outcomes survey showed significant social and emotional improvements.

Custom Pectus Excavatum ImplantA custom pectus excavatum implant made from a 3D CT scan can be a very good option for chest reshaping if one is opposed to any form of invasive thoracic surgery. While it is still surgery it done on top of the chest or from an extrathoracic location. Using a computer-aided design for the implants is superior to an external silastic elastomer mold because it is based on the actual shape of the underlying ribs and sternum. External molds are based on the shape of the external skin which does not have the detail of the underlying supportive cartilage and bone anatomy.

In this incredibly large clinical series in this paper, undoubtably the largest ever reported and probably done in the entire world, there were a surprising very low number of any complications. They did not report the need to remove any implants over the study period which is remarkable. This is a testament to how well the tissues tolerate an implant in an area of relatively low motion and stress exposure.

Dr. Barry Eppley

Indianapolis, Indiana

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