title: Correction of asymmetric pectus excavatum using a virtually designed silicone implant.
abstract: BACKGROUND
  An extended asymmetric funnel chest deformity with the breast gland located in the thoracic mold can lead to a fictitious aplasia of the breast. The authors termed this condition "pseudo-Amazon syndrome" because the breast tissue and the pectoralis muscle are fully developed.
  
  
  METHODS
  This report presents a detailed technical approach to the fabrication of a precise-fitting custom-made silicone implant. The design of the implant was achieved using a computed tomography (CT) data set and rapid prototyping. The volumes of the "hidden" and the normal breasts measured preoperatively by processing the CT data were similar. These volumes were compared with the breast volumes measured by three-dimensional photography 4 years postoperatively to assess the predictability of the volume congruency. The silicone implant was surgically placed in the epicostal plane and extended almost over the right hemithorax.
  
  
  RESULTS
  The implantation was performed without the necessity of further trimming. Both the surgeon and the patient rated the aesthetic and functional long-term result as good in terms of symmetry and the possibility of exercise without restrictions. The final breast volume of the surgically treated side was 95 % of the volume of the normal contralateral breast.
  
  
  CONCLUSIONS
  The described method reduces the operation time and the operative trauma by primary implant fit. However, the method is rather elaborate and the production process is expensive. This in turn reduces the generation of proceeds to a minimum.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. Jens.Wallmichrath@med.uni-muenchen.de.
authors: Jens
authors: J
authors: Wallmichrath
authors: Lymphology of the Surgical Clinic Munich Bogenhausen, Munich, Germany.
authors: Ruediger G
authors: RG
authors: Baumeister
authors: Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors: Riccardo E
authors: RE
authors: Giunta
authors: Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors: Thomas
authors: T
authors: Holzbach
authors: Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors: Andreas
authors: A
authors: Frick
mesh_terms: D018427:Breast Implants; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D011474:Prosthesis Design / Q000379:methods*; D012828:Silicones; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D012828:Silicones