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.