Your Questions
Your Questions
Q: I have a minor case of pectus excavatum on the bottom of my sternum, although I do not believe it is causing me any physical problems such as breathing. I find its indentation to be very disturbing and affects my self-image. I was reading about the case study: Injectable Sternoplasty with Kryptonite Cone Cement on one of your websites and was wondering if this is the treatment would be good for me as I have about the same level of severity as shown in that person. I have had quite a difficult time researching any relevant plastic surgery options for treating this problem.
A: It is no surprise that you have had a difficult time finding any treatment options for minor to moderate sternal contour deformities as they really don’t exist. Short of treatment for more significant cases of pectus excavatum with the Nuss procedure or the older radical method of rib resection, there is no reported methods for sternal ‘augmentation’. In the past, plastic surgeons have occasionally used custom or carved implants for sternal augmentation but these required large incisions to place and were often associated with postoperatuve problems of seromas, infection or implant mobility. Whatever is placed on the sternum, it must be fixed and adhere to the bone to prevent these problems. This is why I have applied a cranioplasty approach to the sternum, specifically a Kryptonite injection approach. This material bonds to the bone and can flow through a very small tube for placement. In my experience with it I have learned that it takes less material than one thinks to fill a lower sternal indentation, usually less than 5 grams due to the expansion of the material
Indianapolis Indiana
Q: My 17 year old son has pectus excavatum which is more pronounced on his left side. It is slight according to the pediatric surgeon we saw and he felt that any sterna reshaping surgery wasn’t justified. He was fitted for a chest brace which was ineffective. Is there anything that can be done that doesn’t involve cutting the bone like some type of implant?
A: Minor cases of pectus excavatum can be cosmetically treated by onlay implant augmentation. There are no specific sternal implants that are available off-the-shelf. In addition, it is desireable to limit the need or size of an incision to minimize scarring. A noticeable scar would make for a poor aesthetic trade-off despite the sternal contour improvement. Therefore, I have found that the use of Kryptonite bone cement currently offers the best treatment option. It can be injected through a small tube, making for a very small incision of just a few millilmeters. Once injected, it can be molded and contoured to smooth out the sterna depression. Another potential option is fat injections. With today’s improved fat concentration techniques, the survival and volume retention of fat is much improved. In small areas like the lower end of the sternum, I would expect fat volume survival to be good. The only negative is that it would be soft rather than firm like a normal underlying sterna bone. Whether this is significant is a matter of debate.
Indianapolis, Indiana
