Can An Injection Method Be Used For Repair of My Pectus Excavatum Problem?

Q: Dr. Eppley, I have an indented lower end of my sternum, I think it is called pectus excavatum. I have read about implants to fix but I don’t want a scar on my chest to put it in nor do I ever want any problems with an implant down the road. I was wondering if I was a good candidate for an injectable method of pectus excavatum repair. That seems perfect to me for my chest problem. I have attached some pictures.

A: Thank you for sending your pictures. You have a very discrete lower tail of the sternal depression or a limited pectus excavatum deformity.  It’s size and location is deal for an injectable form of pectus excavatum repair or sternal augmentation, the question is one of which material to use. The options include your own fat, hydroxyapatite granules or an hydroxyapatite cement. Having used all three for an injectable sternoplasty approach, I would opt for hydroxyapatite granules or fat. While I love injectable fat (and yes even you as a thin guy have enough to harvest) as it is both natural and will never created an abnormal contour problem, it is very prone to partial or complete resorption due to the tight attachment of the sternal tissues. The pressure of the tight overlying skin is the cause of fat atrophy/resorption. How much of the fat will take can not be precisely predicted before surgery. Hydroxyapatite granules can be injected, are very moldable (as they are granules), will not resorb, and have low risk of any contour/shape issue. Any of the bone cements (composed of hydroxyapatite) are great space fillers and are permanent but are very prone to being overfilled or having an irregular shape (as they set as a hard mass), thus requiring a revisional procedure for adjustment should that occur.

Dr. Barry Eppley

Indianapolis, Indiana