Silicone implant correction of pectus excavatum: indications and refinement in technique

Pectus excavatum is the most common deformity of the chest wall. The overwhelming majority of patients with pectus excavatum have no physiologic compromise. Adolescents beyond their growth spurt and adults who are asymptomatic are best served by placement of a silicone implant to correct the chest-wall defect. We have treated 12 patients in this manner. The initial 7 were treated with placement of a subcutaneous implant. Despite patient satisfaction, we noted several problems that compromised the aesthetic result. In the last 5 patients, the implant has been placed subpectorally, and room temperature vulcanizing silicone has been used to augment the preformed silicone implant if necessary. Subpectoral placement of a preformed silicone implant is a relatively minor procedure with a short hospital stay and minimum morbidity. It avoids a major reconstruction of the chest wall with its inherent risks and complications and provides a pleasing aesthetic result. All 5 patients, 4 of whom had severe deformity, have had good results with postoperative follow-ups of between 8 months and 2 years.