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Pectus Excavatum and Breast Asymmetry Reconstruction by Dr. Kao
Pectus Excavatum and Breast Asymmetry Reconstruction: 10-Year Revision by Dr. Kao
This complex breast reconstruction case shows how Dr. Kao corrected breast asymmetry caused by pectus excavatum using implant revision, fat grafting, and structural chest wall support to create a natural, balanced result.
Video: Pectus excavatum and breast asymmetry reconstruction by Dr. Kao
“Normally when you fix pectus excavatum, you do it in childhood. You have to break the ribcage, place pins, and reset the bone. We didn’t do any of that.”
Table of Contents
Case Overview
Dr. Chia Chi Kao first met this patient 10 years ago, when she was 20 years old. She was born with pectus excavatum, a condition where the breastbone is sunken into the chest. In more severe cases, pectus excavatum can make the center of the chest appear scooped out, creating a deep depression in the chest wall.
In this patient’s case, the condition also contributed to significant breast asymmetry. Her right breast was underdeveloped, and the nipple pointed inward because the underlying chest wall was slanted.
The Challenge of Pectus Excavatum and Breast Asymmetry
Traditional pectus excavatum repair can involve invasive chest wall surgery. In some cases, surgeons make an incision on the front of the chest, remove overgrown rib cartilage, and reposition the sternum forward. Plates, screws, or a metal bar may be used to hold the sternum in a better position.
This patient did not want invasive surgery to correct the chest wall defect. However, she did want to improve the smaller breast and create better symmetry.
The challenge was that simply placing an implant on top of the slanted chest wall would have made the inward nipple projection worse. The implant needed a more level foundation so the breast could project more naturally.
Dr. Kao’s Original Reconstruction Plan
Dr. Kao’s solution was to level the sloping chest wall with a customized acellular dermal matrix, also known as ADM. He describes this structural support as an ADM “burrito,” designed to create a more stable and level platform for the implant.
By improving the foundation beneath the breast implant, Dr. Kao was able to help the right nipple project more naturally instead of pointing inward. The result worked very well, and the patient was happy with the improvement.
The only problem was that she did not return for follow-up until 10 years later, when her implant needed to be changed.
10-Year Implant Revision and Fat Grafting
Ten years later, Dr. Kao removed and replaced the right breast implant to better match the patient’s natural left breast. He also performed extensive fat grafting to fill in the remaining chest wall defect and create a smoother, softer, more natural contour.
The final result is balanced and natural. The right implant matches the natural left breast, the nipples no longer point toward each other, and the chest wall depression is much less visible.
This case demonstrates how advanced breast reconstruction can sometimes avoid invasive chest wall surgery while still improving symmetry, breast shape, nipple direction, and patient confidence.
Considering Breast Asymmetry Reconstruction?
Dr. Chia Chi Kao specializes in complex aesthetic and reconstructive breast surgery designed to improve symmetry, contour, proportion, and natural-looking results.
Questions & Answers
What is pectus excavatum?
Pectus excavatum is a chest wall condition where the breastbone is sunken into the chest. In more severe cases, it can create a deep depression in the center of the chest.
How can pectus excavatum affect breast shape?
Pectus excavatum can create a slanted or depressed chest wall foundation. This may cause breast asymmetry, underdevelopment on one side, or inward nipple projection.
Why was a standard breast implant not enough in this case?
Because the patient’s chest wall was slanted, placing an implant directly on top of it could have worsened the inward projection of the nipple. Dr. Kao first needed to create a more level foundation for the implant.
What is ADM in breast reconstruction?
ADM stands for acellular dermal matrix. In this case, Dr. Kao used customized ADM support to help level the chest wall and create a more stable foundation for the breast implant.
What was done during the 10-year revision?
Dr. Kao removed and replaced the right breast implant to better match the natural left breast. He also performed extensive fat grafting to fill in the chest wall defect and improve the overall contour.
About Dr. Chia Chi Kao
Dr. Chia Chi Kao is a board-certified plastic surgeon and the founder of Kao Plastic Surgery in Santa Monica, California. He is known for complex aesthetic and reconstructive surgery, breast revision, facial rejuvenation, body contouring, and natural-looking results designed to restore confidence and harmony.
Individual results vary. This content is for educational purposes only and does not replace a personal consultation with a qualified plastic surgeon. Pectus excavatum can range in severity, and not every patient is a candidate for the same approach.
