Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento / Pectus excavatum and breast asymmetry: correction with breast augmentation

Introdução: O pectus excavatum é definido com uma depressão aproximando o esterno e as cartilagens costais à coluna vertebral. Existem diversas teorias em relação à etiologia; a mais aceita consiste no crescimento exagerado das cartilagens costais, causando um deslocamento posterior do esterno e consequente depressão. Dentre as formas de tratamento, encontra-se a correção das assimetrias mamárias utilizando próteses mamárias de silicone em pacientes sem sintomas cardiopulmonares, apenas com queixa estética. Métodos: Foram revisados os registros em prontuários e registros fotográficos de oito casos de pacientes femininas com diagnóstico de pectus excavatum operadas em um hospital privado na região Sul do Brasil, que procuravam o serviço com queixas estéticas locais, e não apresentavam queixas cardiorrespiratórias. Resultados: Seis casos foram submetidos somente à inclusão de prótese mamária. Uma paciente havia colocado prótese havia 15 anos, sendo essa substituída por novo implante, no mesmo plano. Outra paciente já havia realizado cirurgia de correção de pectus descrito por Nuss, 10 anos antes, vindo a consulta com queixa de hipomastia e assimetria. O tipo anestésico preferido foi a anestesia geral, em cinco dos casos. O plano de inclusão de prótese na quase totalidade dos casos foi o subglandular. Somente uma paciente apresentou complicação (seroma). Conclusões: Evidenciamos, na nossa amostra, que a inclusão de prótese mamária em pacientes com pectus excavatum é capaz de trazer resultados estético harmônicos, atenuando e/ou mascarando o defeito torácico, com resultados estéticos satisfatórios para os pacientes.

Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients.

Prevention of Synmastia in Breast Augmentation of Sunken Chest: Muscle Splitting Concept

BACKGROUND: Synmastia is serious condition but rare. Synmastia is a technical complication caused by over dissection of the medial pocket over the sternum. In sunken chest, the medial portion of Pectoralis muscle tends to be elevated easily from the sternocostal area. So it should be more careful to prevent from overdissection in breast augmentation of sunken chest. METHODS: An idea was obtained from buttock augmentation with implant. For buttock augmentation, implants are placed intramuscularly for the protection of sciatic nerve and for the prevention of implant displacement. Muscle splitting concept for intramuscular placing of implant in sunken chest adds tissue to sunken area and provide guarding barrier to reduce detaching tendency at the parasternal area. RESULTS: As I had the concept of intramuscular placement at the medial side for the breast augmentation in case of sunken chest, I experienced steady medial breast contour in 5 cases of sunken chest. CONCLUSIONS: Muscle splitting as coronal plane of medial portion of pectoral muscle make muscular pouch at the medial corner of subpectoral pocket which is effective for the prevention of medial displacement of implant in breast augmentation of sunken chest by guarding effect of irregularly arranged muscle fibers which resist against the detaching force of pectoral muscle from the sternocostal origin.

Presentación de un caso de corrección cosmética de pectus excavatum / Cosmetic correction of pectus excavatum: A case presentation

El pectus excavatum representa del 90 al 92% de las deformidades congénitas de la pared anterior del tórax; el resto comprende pectus carinatum, tórax hendido, síndrome de Cantrelly síndrome de Poland. En México, se presenta en 1 de cada 1,000 nacidos vivos. La deformidad es poco evidente al nacimiento; sin embargo, en la infancia se hace más evidente y puede llegar a constituir un problema relevante funcional, psicosocial y/o estético para el adolescente. La patogenia se atribuye al crecimiento anormal de los cartílagos costales. Siguiendo el principio fundamental de que toda deformación congénita que produce síntomas reclama la atención del cirujano, se recomienda la cirugía correctiva en la edad temprana de la vida, porque la manipulación operatoria se lleva a cabo en un palmo de extensión. Presentamos el caso de un varón de 18 años de edad, de 1.90 metros de estatura, jugador de baloncesto, a quien se le colocó una prótesis modelada de silicon por debajo del plano fasciomuscular, para corregir el defecto físico.

Pectus excavatum is the commonest congenital defect of the anterior chest wall, accounting for 90-92% of all cases, the rest is distributed between pectus carinatum, cleft sternum, Cantrell's syndrome and Poland's syndrome. In Mexico, pectus excavatum occurs in 1 of 1,000 live births. This deformity is barely noticed at birth but becomes more evident during childhood and may constitute a functional, psychosocial and/or aesthetic problem for the adolescent. The pathophysiology involved is an abnormal growth of costal cartilages. Following the fundamental principle that any symptomatic congenital deformity claims the surgeon's attention, corrective surgery is recommended early in life, when the surgical manipulation is made in a small field. We present the case of an 18 year old, 1.9 m tall, basketball player, who had a modelled silicon implant inserted beneath the fasciomuscular layer, as a cosmetic repair of his deformity.