Clinical Scenario
A 40-year-old male, 1.92 m tall, with a weight of 80 kg and a BMI (body mass index) of 21.7 (ectomorphic body type). Marfan syndrome was ruled out prior to the procedure. The deformity was classified as Type 1/4 Pectus Arcuatum, predominantly affecting the lower sternum (xiphoid) symmetrically.
The deformity had no functional impact but carried significant aesthetic and psychological implications.
Surgery
The pectus excavatum surgery in this patient was relatively straightforward, facilitated by the use of a 3D custom-made implant. Special care was taken with the medial part of the pectoralis major muscle during the upper thoracic dissection. Once the correct costal anatomical plane was identified, the remainder of the dissection proceeded smoothly within the predefined boundaries.
In the abdominal epigastric region, it was crucial to remain under the fascia of the abdominal muscles and preserve the intermuscular septum along the linea alba to prevent implant migration and visibility. Closure was achieved in three layers without tension, ensuring optimal stability of the prosthesis.
Conclusion and Follow-Up
Postoperative compression was essential, applied continuously day and night for one month to stabilize the implant and minimize the risk of seroma formation. Despite this, the patient required three seroma aspirations within the first two weeks post-surgery, performed without ultrasound guidance due to the cohesive silicone implant, which eliminates the risk of rupture.
For severe cases like this one, a custom-made implant is essential to achieve effective correction in a single procedure. If necessary, a lipofilling session can be added three months after surgery to further enhance the aesthetic result.
Author
Dr. Karl Waked, certified plastic surgeon from Ghent, Belgium, completed his training in plastic surgery under the supervision of Prof. Dr. Moustapha Hamdi at UZ Brussels, graduating with the highest distinction.
He further improved his skills in aesthetic and reconstructive surgery in Paris (with Dr. Nicolas Leymarie), Marbella (with Dr. Alexander Aslani), and Munich (with Dr. Milomir Ninkovic). His goal is to provide exceptional care to his patients.
