Treatment of funnel chest or pectus excavatum with custom-made silicone prosthesis

The strong points

  • Computer-assisted pectus excavatum surgery is a procedure that allows you to obtain a customized correction of your deformity.

  • Reliable pectus excavatum surgery for women is finally possible

  • minimally painful chest wall surgery with a 5 cm scar under the breast

Principles of funnel chest treatment

The funnel-shaped thorax or pectus excavatum is the most frequent anterior thoracic malformation. It leads to deformities responsible for an important aesthetic discomfort and very little functional discomfort except in very advanced cases. Its surgical treatment allows an important gain in quality of life.

Funnel chest is defined by a concavity of the central thoracic region (sternum) associated with an excess of curvature of the costal cartilages. It affects 1% of the population, mostly men, and appears during growth. There are 3 types of funnel chest according to Chin's classification:

Type 1 : the malformation is symmetrical and concerns only the sternum
Type 2: the deformity is symmetrical and extends to the pectoral regions
Type 3 : the malformation is asymmetrical and extends to the pectoral regions

There are 3 types of funnel chest surgery

  • Sternochondroplasty: performed by thoracic surgeons. We work as a team with Dr. Emmanuel Brian. Sternochondroplasty involves modifying the structure of the costal cartilage and sternum by means of surgical cuts, stabilized by titanium plates. It is an extensive and painful procedure. It is reserved for patients suffering from significant functional impairment, in particular respiratory problems affecting daily life or sporting activities. A minimally invasive technique known as the Nüss technique involves introducing a convex titanium rod into the thorax to project the sternum. This technique is of interest in types 1 and 2 during the growth period between the ages of 13 and 18, but is less and less common in France.

  • Custom-made silicone prostheses: this is the procedure we've been performing for over 15 years. It is intended for patients suffering from purely aesthetic discomfort, which corresponds to the majority of cases. This aesthetic surgery of the chest wall involves inserting under the skin or under the pectoral muscles a solid silicone prosthesis (no possibility of implant rupture) that has been computer-defined on the basis of a millimetric thoracic scan.

  • Lipofilling of the pectus excavatum. We do not perform this procedure frequently, as it is reserved for less severe cases, which are often well tolerated by patients. In addition, it requires several procedures and a sufficient stock of fat, which is rarely the case in young, slim, athletic men.

The correction of pectus excavatum by silicone prosthesis has recently been revolutionized by the application of computer-aided design techniques. Previously, the implant was made from a plaster mold applied to the patient's thorax by a specialized technician, using alginate (a borrowing paste used by dentists). This method of aesthetic torso surgery had its limitations, particularly in women (the volume of the breast makes it impossible to take a reliable impression), and in Chin type 3.
We now only use methods based on the creation of 3D models from a volumetric CT reconstruction of the patient.
This method enables the implant to be adapted to the millimeter to fill the area.
The implant is then manufactured by SEBBIN Laboratories in solid silicone elastomer. There is no risk of breakage, and its lifespan is estimated at over 25 years.
It is placed under endoscopic control (using a camera), usually under the skin in the center in front of the sternum, and under the pectoralis major muscle on the sides.

We have improved our technique with over 15 years' experience and several hundred patients treated.

We no longer use a scar in the center of the abdomen, and use a single scar under the right breast. The pectoral muscles are no longer sutured in the center, to avoid any deformation when they contract. Instead, we slide the bottom of the implant, after splitting it slightly, under the anterior sheath of the rectus abdominis muscles to stabilize it.

In practice

An initial consultation with your plastic surgeon is necessary to explain the risks and benefits of such an operation.
A thoracic scan will be prescribed and you will be given a quote from the Sebbin laboratories.
A specific compression garment will also be prescribed.

This scan must be analyzed by your surgeon and will be sent to the Sebbin laboratories for planning and production of the implant. This stage lasts on average 1 month.
Finally, a pre-anesthetic consultation must be performed at least 48 hours before the operation.

Questions / Answers

What are the possible complications?

There is a slight risk of a hematoma (blood clot in the operating room) occurring in the 48 hours following surgery. A second visit to the operating room is then necessary.
As with any implant, post-operative infection is rare but possible (less than 1% of cases). In such cases, the implant must be removed and antibiotics administered.
The most frequent complication, which in fact occurs almost systematically, is lymph effusion, which appears within 10 days of the operation. This is due to the need to cut lymphatic channels at the inner edge of the ribs to place the implant. These channels drain excess fluid from the thorax, and this fluid or lymph will flow around the prosthesis. It is therefore necessary to perform between 2 and 4 evacuation punctures at regular intervals.
The edges of the implant may be visible, especially in very thin patients. Correction by injection of purified fat or lipofilling may be considered at a later stage.

What are the steps to take before considering cosmetic surgery for a funnel chest with a custom-made silicone prosthesis?

An initial consultation with your surgeon is necessary to explain the risks and benefits of funnel chest surgery.
A thoracic scan will be requested and an estimate will be established by the Sebbin laboratories after a medical prescription.

You will be asked to pay €2,800 for the implant before starting the design and manufacturing process.

This scan is then analyzed by your surgeon and sent to Sebbin Laboratories for implant planning and production. This stage takes an average of 3 months.
Finally, a consultation with your anaesthetist will take place in the month preceding the operation.

Is the procedure covered by health insurance?

Yes, the surgical act of placing a custom silicone implant is covered by health insurance as well as hospitalization.

However, the implant itself is not reimbursed, and costs range from €1,200 for a cast implant (a technique we no longer use) to €2,800 for an implant designed by computer from a CT scan.

Finally, the surgeon's fees (2500 €) may be reimbursed by your health insurance.

How much does funnel chest surgery with a custom silicone prosthesis cost?

In case of coverage by the health insurance, our surgical fees amount to 2500 € possibly covered by your mutual insurance company.

The implant is not covered by health insurance or your mutual insurance company. The cost is 2800 euros in May 2023.

To learn more about the treatment of Pectus Excavatum on the Anatomik Modeling website, click here.

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The firm

Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France

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