Q: Dr. Eppley, I am interested in getting a pectoral implant on just one side. I have pectus excavatum on the right side of the sternum/chest and have been treated with fat inejctions. They did not do as much as I wanted due to some fat resorption. I think if I just had a small pectoral imnplant as opposed to a full one on that side that would make it much better and no volume would be lost. My question is how would this implant behave with years of abuse (contracting the muscle) through physical work, and working out the chest. and since it would be placed under the muscle it should be rather invisible during the movement of the muscle right? How long have your patients gone with implants? A silly question about this implant, would it be permanent and to my understanding the longer the implant would be under the muscle the more the chances of complications(movement) decrease?
A: Physical activity and chest muscle action have no negative effects on a submuscular pectoral implant or vice versa. Pectoral implants (whole or partial) under the muscle are not seen on the outside. It is implants that are above the muscle in the chest that have concerns in these regards. Pectoral implants are made of a soft silicone elastomer that does not degrade, this it is permanent and would never need to be replaced. I know of no pectoral implant patients who have ever had long-term problems with their implants. The only potential issues are short-term after surgery with the very low risks of infection or seroma formation.
Dr. Barry Eppley
Q: Dr. Eppley, I have poland syndrome, dextrocardia and pectus excavatum. My left side chest is sunken because of pectus excavatum and heart is located on right side because of dextrocardia. I do not have any disabilities in my day to day activities but I’m not happy with the physical appearance of my chest. Also, since I got Poland syndrome the left side of my chest seems to be slightly smaller while compared to the right side. I had undergone a plastic surgery procedure a few years ago in which my back muscle was transposed to fill the absence of pectoralis muscle but still the shape is not good. After going through your website I felt you could help me to get my left chest same to look more like my right. I have been analyzing various options and I came across the application of kryptonite in filling up the dent due to pectus excavatum so I thought the same procedure can also be used for my case. But still the muscle is absent which may need fat grafting from other parts of the body or adjustment of LD muscle further. Please find attached photos for your kind review. I request you to kindly advise me on your recommendations.
A: I have taken a look at your pictures and what I see is a lack of pectoral/chest volume on the left side and a typical high positioned nipple. I do think you would benefit by volume addition but I would not use bone cement. Besides the fact that Kryptonite is no longer commerically available, it would be very difficult to get it in the right place and have a smooth contour. The chest volume you are missing is much more than a cement can do anyway. I would use a modified pectoral silicone implant as you already have the LD muscle flap coverage for it. It could be inserted through the upper end of your midline abdominal scar. This would add volume without increasing scar burden. In addition, I would do an inferior crescent nipple lift to move it downward. This would not create complete horizontal nipple symmetry with the other side but would be helpful. Usually you can get about a cm. nipple movement. These would be two helpful manuevers to lessen your current degree of chest asymmetry.
Dr. Barry Eppley