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In most cases, performing a breast augmentation procedure is a relatively straightforward process. However, there are some congenital deformities to the chest wall structure that may require the cosmetic surgeon to take extra care in performing a breast augmentation procedure. Two such deformities are pectus carinatum or pectus excavatum. Both require extra care in terms of implant positioning and profile.

Pectus Carinatum

Pectus carinatum, or “pigeon chest,” is a congenital deformity of the rib cage and sternum in which the breastbone overly protrudes, giving the chest a bird-like appearance. This condition occurs in approximately one in 400 patients. The entire chest wall is bowed outward because the sternum protrudes outward, with depressions along the sides of the chest. Although this condition does not affect the development of the heart and lungs, patients may have pulmonary difficulties due to a chest wall that will appear very rigid. Correction for this condition in severe cases may involve repositioning the sternum with wires or rods.

The breast augmentation goal for these patients is to reduce the appearance of the protruding sternum, while still creating natural-looking cleavage. High profile implants (in which the height of the implants is greater than the base width) placed behind the chest muscles (subpectoral) will reduce the appearance of a protruding sternum. This will produce more natural-appearing cleavage. However, patients must be aware that the implants may become displaced to the outer sides of the chest over time if they do not wear a bra. I recommend patients wear a nocturnal breast support garment to prevent this implant displacement.

Pectus Excavatum

By contrast, cases where the chest bows inward are known as pectus excavatum, or “sunken chest.” This is actually the most common of all congenital chest deformities. Patients with this condition will have a sternum that appears pressed inward relative to the rest of the chest wall. The ribs may also be depressed, which furthers the concave appearance of the chest. Although patients will not have any symptoms in most cases, they can have cardiac difficulties if the heart is compressed between the sternum and the spine.

Patients with this condition will often consider breast augmentation in order to reduce the appearance of the hollowed-out chest. In such cases, low profile implants (in which the implant height is less than the width) placed under the pectoral muscles are preferred. Because chest tissue in patients with pectus excavatum tends to be thin, placing implants over the chest muscle may increase chances for visible implant rippling.

Just as with pectus carinatum, patients with sunken chests who undergo breast augmentation may also experience implant displacement if they do not wear a bra on a regular basis. However, in these cases, the implants may shift toward the sternum, creating the “uniboob” effect. I would also recommend a nighttime support garment to help hold the implants in place.

*The content in this blog is developed to spread the awareness towards plastic surgery. Our blog is not intended to serve as a replacement for an actual in-office consultation with Dr. Marin. As such, the information within this blog reflects the unique cases of our individual patients.

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In light of the state wide restrictions on non-essential businesses to help reduce the spread of COVID-19, we are rescheduling all of our elective appointments until the global circumstances improve. Our necessary post-operative appointments will be made, as needed, to address immediate surgical concerns such as suture removal and acute postoperative issues. All non-acute follow up appointments, fillers and Botox will need to be postponed until after the quarantine period mid April. Our office will reach out to all patients who need to be rescheduled.

We will be offering new patient virtual consultations online and via Skype that can be scheduled through our website or by emailing Also, we will offer follow-up appointments in the same manner to help manage our patients’ concerns while still respecting the need for social distancing.

We appreciate all of your understanding during these difficult times for all of us.

Stay safe,

Dr. Main and the Marin Aesthetics Team