[Submuscular Nuss procedure using mammary areola incision for adult pectus excavatum with significant upper chest...

Submuscular Nuss procedure using mammary areola incision was performed on adult pectus excavatum. The skin was incised approximately 3 cm (almost half the entire areolar circumference). The subcutaneous tissue and pectoralis major muscle were incised to reach the 4th rib. The pectoralis major muscle and serratus anterior muscle were separated from the costae and intercostal muscle. A part of the 3rd intercostal muscle was removed. The sternum and cartilages were robust; therefore the anterior chest wall was elevated with a jack allowing Nuss procedure. After fixing a bar, a drainage tubes were placed beneath the bilateral pleural cavity and muscular layer. Then, the pectoralis major muscle was sutured and the subcutaneous tissue was closed with 2 layers of suturing. The skin was closed with 6-0 nylon sutures, leaving no obvious scar. The mammary areola incision which is used for breast cancer can also successfully applied to Nuss procedure. The Nuss procedure using mammary areola incision is recommended for pectus excavatum with upper chest depression.