How Can I Make The Look Of My Flared Ribs Less With More Chest Projection?

Q: Dr. Eppley, I’m interested in procedures that could address the look of my chest after my Nuss procedure; the bar was implanted about a decade ago and removed years after. The surgery was successful in that my breathing, sternum and Haller index are now close to normal. However, because of my flared ribs, after several years of weightlifting, my chest still looks underdeveloped. One of the inner corners of my pectoral muscle close to the sternum also appears to have a small defect, as if a 1 inch bite were taken out (only visible when I have very low body fat) 

I’ve attached a couple of photos of me from the front and side in my natural posture (i.e. some anterior pelvic tilt); you can see the Nuss scars. I also took a photo where I tried to make it easier to see where my rib cage is.

My goals would be to minimize the look of my flared ribs with minimal scars by making my pectoral muscles larger/more normal (i.e. in front of my ribs rather than behind). I imagine there might be a variety of different options to address this, so I would be curious if you could share what a couple of options and costs might be, from least to most expensive.

Thank you for your advice!

A: Thank you for your inquiry and sending your pictures. From your description your chest reshaping goal is to narrow the wide sternal gap between the medial borders of the pectoralis major muscles. You are correct in that augmentation of the medial border of the muscles would help in that regard and that such augmentation needs to be on the outside of the muscle and not beneath it.

While this is the correct concept, achieving that effect is a challenging one. The use of an implant to achieve that type of extramuscular change requires a low sternal incision to place it and getting an implant with the right shape, thickness and with perfectly feathered edges is a design challenge. Since this is soft tissue augmentation and not bone there is no great way to use 3D CT scanning for implant design. This would have to be based on external measurements/designing. (which is not all that uncommon)

The far simpler and scarless approach is with the use of fat injections and you have the abdominal/flank donor sites in which to harvest. The ever present problem with fat injections is that their survival is far from assured and direct placement into the muscle may not necessarily provide the desired medial muscle edge enlargement closer to the sternum.

Dr. Barry Eppley

Indianapolis, Indiana