Design 3D en CAO d'un implant 3D sur-mesure

How to treat Pectus Excavatum ?

Author : Pr Jean-Pierre Chavoin, ex-Head of Plastic Surgery Department of Toulouse University Hospital, ex-President and General Secretary of French Plastic Surgery Society.

Pectus Excavatum is a malformation of the thorax characterised by a median or lateral depression of the sternum. As concerns women, it can lead to breast's deformity or asymmetry. Funnel chest occurs in 1 to 2% of the population. The impact is mainly aesthetic and psychological, and very rarely functional.

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The 3D custom-made implant technique consists of filling the "hole" in the chest without touching the rib cage unlike traditional orthopedic techniques such as Nuss or Ravitch. Each implant is designed to adapt to the patient's own anatomy. The intervention is simple and painless with a quick recovery. The results are immediate.

Pectus Excavatum : 3D custom-made technique

Custom technique

Each implant is unique and customised for each patient :

  • Realisation of a chest scan at the hospital
  • Segmentation of all tissues and production of a virtual copy of the patient's body
  • Design of the virtual implant that adapts perfectly to the recipient site
  • Machining of a prototype, perfect copy of the implant, for the development of a mold
  • Final manufacturing of the silicone implant from the mold

Custom-made implant

Silicone implant

Implants are made with the latest-generation polymerised silicone and are definitive :

  • Medical-grade polymerized silicone rubber from NuSil, registered with the FDA (Food & Drugs Administration)
  • Smooth implants , puncture-resistant and tear-proof gum, no risk of rupture or shrink shell as for silicone gel breast implants
  • implants are then manufactured by our partner SEBBIN according to the standards ISO 9001 and ISO 13485 meeting the requirements of the European Directive 93/42
Surgeon in the operating room treating a Pectus Excavatum

Pectus Excavatum Surgery

The surgery for a funnel chest takes place under general anesthesia and lasts in average 1 hour and presents minimal risks :

  • The surgeon makes a preoperative drawing on the patient's skin to mark the exact position of the implant,
  • He performs a 7-cm vertical median incision and prepares the locus to the size of the implant for a perfect stability,
  • The implant is deeply slipped into the locus under the muscle, so that it is completely invisible,
  • The surgeon closes the wall in 3 planes with absorbable intradermal stich,
  • The duration of hospitalization is 3 days maximum.

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Surgical outcomes

Surgical outcomes are simple with a rapid recovery :

  • Short and little post-operative pain treated with simple analgesics
  • The stitches are resorbable, no drain, only a dressing for 8 days and a compression bra to wear for 1 month
  • Between 2 and 5 seroma punctures in the locus
  • Sick leave for 15 days and sports restriction for 3 months
  • Immediate result even if it takes 1 month for the oedema to resolve and 1 year for the scar to fade.

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Results

The 3D custom-made technique enables excellent morphological results regardless of the sex, age or type of deformity. The PRS article shows that 80% of the patients are satisfied or very satisfied with this intervention.

Before/After picture of a female Pectus Excavatum
Before/After picture of a male Pectus Excavatum

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Clinical case

Asymptomatic Ravitch Redo by Pr Redmond

Pr Redmond's clinical case

Diagnosis and surgery of an asymptomatic Pectus Excavatum Ravitch Review.

The patient is a 38 yo man who underwent a Ravitch technique surgery to treat his sunken chest but the surgery failed, the chest is still sunken and we can see the heart beating through the skin.

The goal of the surgery is to protect the heart and to fill the hole with a custom-made implant so the patient can get a normal life.

This is about correcting a Pectus defect and review the first Ravitch surgery, improving the overall cosmesis.

Read it

Interview

Mr Ian Hunt's Interview on Pectus Excavatum

"I was intrigued to learn of a new technique which I thought would be very beneficial to patients particularly who have no symptoms of pectus deformities."

"Pectus clinic is really aimed at being able to offer patients guidance around the diagnosis, investigations if required, and treatment options that they may have for their underlying chest wall deformity."

"I've found it particularly valuable in cases where you were looking to do a revision operation finding a patient's Nuss or Ravitch operation which has left them with an unsatisfactory result."

"I think as a thoracic surgeon performing a lot of pectus surgeries that I appreciate the challenges around performing revision to corrective surgery and I think Pectus implants have a very good role in offering surgery to patients who otherwise are unhappy with their first corrective surgery."

Testimonials

Surgeon

As an experienced thoracic surgeon performing corrective pectus excavatum surgery routinely I was seeing patients who did not wish to go through such an invasive procedure with its associated period of recovery.

Ian Hunt, MD, The Pectus Clinic, London (UK)

Surgeons testimonials

Patient

Before the operation I was self-conscious about taking my shirt off in public or doing any water based activities. I said to my dad I would like to see if there is anything out there that can fix my chest. After looking at various surgery’s I was more interested in just a cosmetic fix.

Edward, 19 years old, West Yorkshire (UK)

Patient testimonials

Frequently asked questions

Can you combine the insertion of these custom‑made implants with breast implants?

Yes but in two surgeries, spaced at least 6 months apart, starting always with the thoracic implant. If breast asymmetry is due to Pectus Excavatum, the mere presence of the thoracic implant can sometimes correct the asymmetry and increase the size of the breasts.

Regarding the Pectus Excavatum, what is the advantage compared with the Nuss or Ravitch techniques?

This technique requires only one surgery, without orthopaedic change to the chest cavity, and therefore much less invasive, painful and disabling. This technique does not present any risk of recurrence or poor performance.

Can you get a custom-made implant if you already performed a Nuss or Ravitch surgery ?

Patients who had to remove a Nuss or Ravitch bar or either are not satisfied with the morphological results of those techniques can get a 3D custom-made implant. This filling technique presents minimal risks and fits perfectly to asymetric Pectus, hard to treat with traditional orthopedic surgeries.
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