title: Aesthetic improvement of the female breast in funnel chest deformity by surgical repair of the thoracic wall:  indication or lifestyle surgery?
abstract: BACKGROUND
  Adults are increasingly seeking surgical correction of pectus excavatum deformity, and the alternative custom-made silicone implant is not always desired or suitable. The paramount concern of female patients is the apparent strabism of their breasts. In some cases, the standard minimally invasive reconstruction of pectus excavatum procedure or a modified approach with a semiopen technique can help remodel the anterior thoracic wall and simultaneously reposition the female breasts to a desired and aesthetically acceptable position.
  
  
  METHODS
  Between November of 2000 and March of 2011, 35 female adolescent and adult patients underwent surgical funnel chest repair with different approaches. In seven of these patients, a pectus bar was implanted using minimally invasive reconstruction of pectus excavatum, whereas 15 underwent a combined semiopen approach. The pectus bar was removed after a period of 14 to 39 months (mean, 31 months) in the minimally invasive reconstruction group and 12 to 25 months (mean, 13.5 months) in the other group. Preoperative and postoperative photographs were examined, and the results were assessed by independent surgeons.
  
  
  RESULTS
  During the follow-up period of 1 month to 3.9 years (mean, 12 months), no major complications occurred. The aesthetic appearance of the anterior thoracic wall was distinctly improved, and breast strabism and breast tissue projection were eliminated.
  
  
  CONCLUSIONS
  Pectus bar implantation appears to be an excellent method for the correction of breast malposition in female adults with a funnel chest deformity. Although invasive, it allows permanent remodeling of the anterior thoracic wall and the décolleté, and a repositioning of the female breast to achieve a natural appearance.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Innsbruck, Austria From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Innsbruck Medical University.
authors.forename: Anton H
authors.initials: AH
authors.lastname: Schwabegger
authors.forename: Barbara
authors.initials: B
authors.lastname: Del Frari
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
mesh_terms: D000293:Adolescent; D000328:Adult; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult