Pectus excavatum is a chest wall malformation characterized by anterior chest wall depression. It is often associated with hypoplastic breasts, sternal rotation, and consequent breast asymmetry. We present here the case of a 52-year-old female with pectus excavatum, a bilateral nipple-sparing mastectomy for breast cancer, and immediate autologous breast reconstruction using bilateral deep inferior epigastric perforator flaps. To correct reconstructed breast deformities and pectus excavatum depression and to enhance breast volume to treat hypoplastic breasts, three sessions of Brava-assisted fat grafting were performed. These postoperative courses were uneventful and without any complications. The patient was satisfied with the final esthetic results. There are only two case reports to perform bilateral breast reconstruction and surgical correction of pectus excavatum, which were used with both pedicle musculocutaneous flap and breast implant, with or without a sternal implant. In this study, we discuss indications and surgical options for bilateral breast reconstruction, pectus excavatum, and breast augmentation.
Level of Evidence: Level V, therapeutic study.
Pectus excavatum Breast cancer Breast reconstruction Deep inferior epigastric artery perforator flap Breast augmentation Fat grafting
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflict of interest
Toshihiko Satake, Mayu Muto, Seiko Kou, Jun Sugawara, Kazutaka Narui, Shinji Kobayashi, Takashi Ishikawa and Jiro Maegawa declare that they have no conflicts of interest.
For this type of study formal consent is not required.
Informed consent was obtained from the patient before her inclusion in this study.
Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E (2013) Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 33(6):822–829CrossRefPubMedGoogle Scholar
Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (1998) A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33(4):545–552CrossRefPubMedGoogle Scholar
Rose EH, Lavey EB (1983) Correction of bilateral breast hypoplasia and pectus excavatum with single-unit customized silicone implant. Plast Reconstr Surg 72(2):234–236CrossRefPubMedGoogle Scholar
Moscona RA, Fodor L (2011) How to perform breast augmentation safely for a pectus excavatum patient. Aesthet Plast Surg 35(2):198–202CrossRefGoogle Scholar
Guimarães J, Maia M, Monteiro E, Ferraro A (2001) Aesthetic correction of mild pectus excavatum with autologous tissue during mastopexy. Plast Reconstr Surg 108(3):757–762CrossRefPubMedGoogle Scholar
Schwabegger AH, Piza-Katzer H, Pauzenberger R, Del Frari B (2011) The internal mammary artery perforator (IMAP) breast-flap harvested from an asymmetric hyperplastic breast for correction of a mild funnel chest deformity. Aesthet Plast Surg 35(5):928–932CrossRefGoogle Scholar
Michlits W, Windhofer C, Papp C (2009) Pectus excavatum and free fasciocutaneous infragluteal flap: a new technique for the correction of congenital asymptomatic chest wall deformities in adults. Plast Reconstr Surg 124(5):1520–1528CrossRefPubMedGoogle Scholar
Dionyssiou D, Demiri E, Batsis G, Pavikidis L (2015) Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap. Indian J Plast Surg 48(1):85–88CrossRefPubMedPubMedCentralGoogle Scholar
Pereira LH, Sterodimas A (2008) Free fat transplantation for the aesthetic correction of mild pectus excavatum. Aesthet Plast Surg 32(2):393–396CrossRefGoogle Scholar
Raab N, Holm-Muehlbauer C, Ninkovic M (2009) Free superficial inferior epigastric artery flap for aesthetic correction of mild pectus excavatum. Plast Reconstr Surg 123(6):209e–211eCrossRefPubMedGoogle Scholar
Park HJ, Lee SY, Lee CS, Youm W, Lee KR (2004) The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thoracic Surg 77(1):289–295CrossRefGoogle Scholar
Haller JA, Kramer SS, Lietman SA (1987) Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 22(10):904–906CrossRefPubMedGoogle Scholar
Rha EY, Kim JM, Yoo G, Jeong JY, Hwang DK, Kim KJ (2015) Is breast asymmetry caused by volume differences in women with pectus excavatum? J Plast Reconstr Aesthet Surg 69(4):470–474CrossRefPubMedGoogle Scholar
Ma IT, Rebecca AM, Notrica DM, McMahon LE, Jaroszewski DE (2015) Pectus excavatum in adult women: repair and the impact of prior or concurrent breast augmentation. Plast Reconstr Surg 135(2):303e–312eCrossRefPubMedGoogle Scholar
Park HJ, Gu JH, Jang JC, Dhonq ES, Yoon ES (2014) Correction of pectus excavatum with breast hypoplasia using simultaneous pectus bar procedure and augmentation mammoplasty. Ann Plast Surg 73:190–195CrossRefPubMedGoogle Scholar
Beier JP, Weber PG, Reingruber B, Huemmer HP, Kneser U, Draqu A, Horch RE, Bach AD (2009) Aesthetic and functional correction of female, asymmetric funnel chest - a combined approach. Breast 18:60–65CrossRefPubMedGoogle Scholar
Rapuzzi G, Torre M, Romanini MV, Viacava R, Disma N, Santi PL, Jasonni V (2010) The Nuss procedure after breast augmentation for female pectus excavatum. Aesthet Plast Surg 34:397–400CrossRefGoogle Scholar
Coleman SR, Saboeiro AP (2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 119(3):775–785CrossRefPubMedGoogle Scholar
Delay E, Sinna R, Chekaroua K, Delaporte T, Garson S, Toussoun G (2010) Lipomodeling of Poland’s syndrome: a new treatment of the thoracic deformity. Aesthet Plast Surg 34(2):218–225CrossRefGoogle Scholar
Yang H, Lee H (2011) Successful use of squeezed-fat grafts to correct a breast affected by Poland syndrome. Aesthet Plast Surg 35(3):418–425CrossRefGoogle Scholar
Klit A, Siemssen PA, Gramkow CS (2015) Treatment of congenital unilateral hypoplastic breast anomalies using autologous fat grafting: a study of 11 consecutive patients. J Plast Reconstr Aesthet Surg 68:1106–1111CrossRefPubMedGoogle Scholar
Rudolph R (1986) Buried transverse abdominal myocutaneous flap and silicone implants to reconstruct pectus excavatum and bilateral mastectomy deformity. Plast Reconstr Surg 78(6):817–819CrossRefPubMedGoogle Scholar
Mishra A, Kain N, Constantinides J, McPhail J, Iqbal A (2010) Customised chest wall implant to correct pectus excavatum and bilateral breast reconstruction with muscle-sparing latissimus dorsi (MS-LD) flap in a single stage. J Plast Reconstr Aesthet Surg 64(5):e132–e134CrossRefGoogle Scholar
Spear SL, Wilson HB, Lockwood MD (2005) Fat injection to correct contour deformities in the reconstructed breast. Plast Reconstr Surg 116(5):1300–1305CrossRefPubMedGoogle Scholar
Weichman KE, Broer PN, Tanna N, Wilson SC, Allan A, Levine JP, Ahn C, Choi KNS, Allen R (2013) The role of autologous fat grafting in secondary microsurgical breast reconstruction. Ann Plast Surg 71(1):24–30CrossRefPubMedGoogle Scholar
Khouri RK, Eisenmann-Klein M, Cardoso E, Cooley BC, Kacher D, Gombos E, Baker TJ (2012) Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg 129(5):1173–1187CrossRefPubMedGoogle Scholar
Uda H, Tomioka YK, Sugawara Y, Sarukawa S, Sunaga A (2015) Shaping of the unaffected breast with Brava-assisted autologous fat grafting to obtain symmetry after breast reconstruction. Aesthet Surg J 35(5):565–573CrossRefPubMedPubMedCentralGoogle Scholar