Q: Dr. Eppley, I have significant pectus excavatum which I want improved. I had a Nuss procedure done many years ago and, although it is improved, I am not satisfied. I have already explored the option of silicone implants but didn’t preferred it since it is artificial and I don’t want the risk in future for problems with it or any further surgery. I request you to kindly advise me an alternative option other than silicone implants. I had been exploring the
option of “artificial bone”. I understand artificial bones are almost like natural bone and so I would like to use the artificial bone for the dent portion and fat grafting for remaining portion of the chest above the dent filled portion. I request you to kindly advise me on having the option of artificial bone and fat grafting for attaining the required shape of the chest.
A: I am afraid that you confusing synthetic bone substitutes as having the same physical properties of natural bone, which they do not. There are hydroxyapatite cements which ultimately behave more like ceramics. They do not
become bone nor do they act like real bone. In essence, they will not result impact trauma and will fracture. They work well on the skull and face where the risk of impact injuries are fairly low but also have the benefit of being covered by thick well-vascularized soft tissue over relatively smooth convex surfaces. On the chest for small or minor amounts of pectus excavatum, I think they are fine because the surface area being covered is small. But when trying to use them to cover larger sternal/rib areas in more substantial pectus excavatums, the material is more exposed to the potential for fracture. In short, they should not be considered for use for chest volume restoration because that is beyond their potential for long-term success.It is possible that the lower end of the pectus excavatum could be treated with hydroxyapatite cement and then injectable fat grafting for the other larger areas of the chest deficiency.
Dr. Barry Eppley