The chest is exposed to a variety of deformities of its bony and cartilaginous structures. The curve of the ribs around the chest and their attachment to the sternum create an architecture that can become disturbed. One of the most recognized of these deformities is pectus excavatum. This chest wall deformity is most typified with the sunken appearance of the lower end of the sternum. This is associated an outerward flare of the lower ribs and a broader concavity of the upper rib cartilages. Despite the basic anatomic components of pectus excavatum, it comes in a wide range of presentations. It is not always symmetric and can appear just one side.
Surgery for correction of pectus excavatum has been around for decades. It has evolved from open rib resections to the placement of metal bars behind the sternum to create an outward push for a chest wall reshaping effect. But many of these procedures are helpful they rarely provide a perfect correction. And the invasiveness of surgery, particularly in younger patients who have a lot of growth to undergo, can led to their own chest wall abnormalities as well.
In adults residual sterno-pectoral chest wall deformities can be treated by the placement of implants to improve their contours. While in the past such chest wall implants have been made by a variety of different methods and materials, a custom approach is used today. This can be done by either a direct moulage on the patient’s chest from which the implant is made or the implant can be made directly from a design done on the patient’s 3D CT scan of their chest.
Because of better design methods, more complete sternal or larger sterno-pectoral implants are now possible. Bigger designs of course requirer larger incisions to insert. But often pre-existing scars make this less of an aesthetic concern.
Dr. Barry Eppley