Special aspects in females

Abstract

The minimally invasive correction of the funnel chest deformity utilizing metal struts [1, 9, 10] refined by Weber and Huemmer to the new Erlangen technique [25] as well as by Nuss [14] to the so-called MIRPE (Minimally Invasive Reconstruction of Pectus Excavatum) technique nowadays predominantly is carried out in children and adolescents [5]. This type of surgical correction at this age, if indicated by medical reasons, is ideal because the thoracic skeleton in particular the anterior thoracic wall is present with yet sufficient flexibility in order to give way to the pressure by a transsternally implanted metal strut or retrosternally placed pectus bar. The original MIRPE method on the other hand however is the fewer an ideal treatment method, the older patients are. Because with body maturation at adulthood the skeletal structures increase their rigidity thus by methods of internal suspension, likewise with a metal strut, the thoracic wall becomes less moldable [7, 26]. However, many patients seek the contact of the physician for the first time in adulthood with a strong desire to have their deformity at the breast corrected. With minor or only moderate extent of pectus excavatum deformities and absence of cardiopulmonal restriction silicone implants may very well fulfil the requirements of presternal volume augmentation, as well as lipofilling [3, 18] may do that (Chapters 6.5 and 6.6.2).