What remedies are available for increasing breast size where a congenital condition of pectum excavatum is present?

I just received 300 cc, high-profile silicone implants a week ago, placed under-muscle. Although I am tall and lean (5'8", 144 lbs, 32A/B prior to surgery), my doc said he could not place anything larger than 300 cc because of the pectum excavatum. Anything larger makes my nipples point inward due to the inward trajectory of my chest wall. I am happy with any size increase I can get, but still feel that I will be too small once I drop and fluff. Are there any other options available for me?

Answers from doctors (16)


Larry Leverett, MD, FACS

Published on Nov 11, 2016

Your nipples are going to point inward regardless of the implant size, and the cleavage will be exaggerated. Choose the size that gives the augmentation that you are desiring. (If you go too small, you will ultimately end up paying again to get what you really wanted the first time).

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Answered by Larry Leverett, MD, FACS

Your nipples are going to point inward regardless of the implant size, and the cleavage will be exaggerated. Choose the size that gives the augmentation that you are desiring. (If you go too small, you will ultimately end up paying again to get what you really wanted the first time).

Published on Jul 11, 2012


Barry J. Kaplan, D.O.

Published on Jun 08, 2016

If you had surgery, wait. Given the details you provided, you will likely be a D in a Victoria's Secret. Not sure I agree with your surgeon's opinion about not being able to go larger, but the pectins will give you a killer cleavage and a D is pretty good.

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Answered by Barry J. Kaplan, D.O.

If you had surgery, wait. Given the details you provided, you will likely be a D in a Victoria's Secret. Not sure I agree with your surgeon's opinion about not being able to go larger, but the pectins will give you a killer cleavage and a D is pretty good.

Published on Jul 11, 2012


Kenneth L. Stein M.D. FACS

Published on May 11, 2016

In Dr. Stein's experience with this condition, he has used auto fat transfer to create a more attractive chest wall.

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Answered by Kenneth L. Stein M.D. FACS

In Dr. Stein's experience with this condition, he has used auto fat transfer to create a more attractive chest wall.

Published on Jul 11, 2012


Edward Domanskis M.D.

Published on Apr 26, 2016

It is difficult to say without seeing you, but the imaging system that we have available would show you what we could do with different shaped implants and sizes.

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Answered by Edward Domanskis M.D.

It is difficult to say without seeing you, but the imaging system that we have available would show you what we could do with different shaped implants and sizes.

Published on Jul 11, 2012


Steely Plastic Surgery

Published on Aug 24, 2015

An interesting question that is difficult to answer without an exam. I will say however that having your 300cc implants placed and giving things 8 months or so to allow the skin to stretch may allow a larger implant to be placed in the future. Fat grafting may also allow a fuller look without sacrifice
I hope this helps

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Answered by Steely Plastic Surgery

An interesting question that is difficult to answer without an exam. I will say however that having your 300cc implants placed and giving things 8 months or so to allow the skin to stretch may allow a larger implant to be placed in the future. Fat grafting may also allow a fuller look without sacrifice
I hope this helps

Published on Jul 11, 2012


Your plastic surgeon is correct. With a pectus excavatum you are limited in implant size based on the base width of your breasts and your soft tissue stretch. An implant too wide will create a synmastia and too projecting will result in an inward displacement of your nipple and areola. You may be a candidate for fat grafting to the breast to add additional volume and fullness. I recommend you discuss this further with your plastic surgeon after you have allowed yourself more time to heal. It's still very early in the healing process. Take care.

Answered by Charles A. Messa, III, M.D., F.A.C.S. (View Profile)

Your plastic surgeon is correct. With a pectus excavatum you are limited in implant size based on the base width of your breasts and your soft tissue stretch. An implant too wide will create a synmastia and too projecting will result in an inward displacement of your nipple and areola. You may be a candidate for fat grafting to the breast to add additional volume and fullness. I recommend you discuss this further with your plastic surgeon after you have allowed yourself more time to heal. It's still very early in the healing process. Take care.

Published on Jul 11, 2012


Tracey H. Stokes M.D., F.A.C.S.

Published on Aug 05, 2015

Let these settle and see how you feel. You can always exchange them to larger implants down the line.

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Answered by Tracey H. Stokes M.D., F.A.C.S.

Let these settle and see how you feel. You can always exchange them to larger implants down the line.

Published on Jul 11, 2012


Bradley Hubbard M.D.

Published on Aug 05, 2015

Your doctor was absolutely correct. You shouldn't go too big with pectus deformity. The results are always disappointing. I would have to see pictures or perform a physical exam to know exactly how big "too big" is for you, but it sounds like you have a very smart PS. Best of luck!

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Answered by Bradley Hubbard M.D.

Your doctor was absolutely correct. You shouldn't go too big with pectus deformity. The results are always disappointing. I would have to see pictures or perform a physical exam to know exactly how big "too big" is for you, but it sounds like you have a very smart PS. Best of luck!

Published on Jul 11, 2012


Stephen M. Davis, MD, FACS

Published on Aug 04, 2015

It is so hard to answer this without per and post-op photos, and to that a pectus and asymmetry. Any answer would just be speculation. I would follow your Board Certified Plastic Surgeons post-op instructions carefully and completely. You will do well.

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Answered by Stephen M. Davis, MD, FACS

It is so hard to answer this without per and post-op photos, and to that a pectus and asymmetry. Any answer would just be speculation. I would follow your Board Certified Plastic Surgeons post-op instructions carefully and completely. You will do well.

Published on Jul 11, 2012


Gerald Minniti, M.D., F.A.C.S

Published on Aug 04, 2015

It's way too early to tell if you'll be satisfied, but the alternatives include revision augmentation with larger implants or fat grafting. You would need to be examined for any definitive suggestion.

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Answered by Gerald Minniti, M.D., F.A.C.S

It's way too early to tell if you'll be satisfied, but the alternatives include revision augmentation with larger implants or fat grafting. You would need to be examined for any definitive suggestion.

Published on Jul 11, 2012


More About Doctor Tom Pousti, M.D.

Published on Aug 04, 2015

Thank you for your question.
Because you are only 1 week out from surgery, I would suggest (as I do with all patients) to allow things to completely heal and settle before considering more surgery. Performing breast surgery on patients with Pectus Excavatum is tricky and experience is key. I would allow your surgeon to get you through the recovery process before you decide to go larger in size.
Best wishes for a result that you will be pleased with.

Answered by Tom Pousti, M.D. (View Profile)

Thank you for your question.
Because you are only 1 week out from surgery, I would suggest (as I do with all patients) to allow things to completely heal and settle before considering more surgery. Performing breast surgery on patients with Pectus Excavatum is tricky and experience is key. I would allow your surgeon to get you through the recovery process before you decide to go larger in size.
Best wishes for a result that you will be pleased with.

Published on Jul 11, 2012


Remus Repta M.D.

Published on Aug 04, 2015

Great question. Fat transfer may be a good option. In doing so, the inner part of your chest can be built up to help with the issue.

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Answered by Remus Repta M.D.

Great question. Fat transfer may be a good option. In doing so, the inner part of your chest can be built up to help with the issue.

Published on Jul 11, 2012


Sheila Nazarian M.D.

Published on Aug 04, 2015

A 300cc implant for your build sounds reasonable. That size will give you the flexibility to look conservative with a lace bra and more voluptuous with a push up bra.

There are chest wall reconstructions for left is excavatum that are done for severe cases but they are big surgeries and probably not worth it in your situation.

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Answered by Sheila Nazarian M.D.

A 300cc implant for your build sounds reasonable. That size will give you the flexibility to look conservative with a lace bra and more voluptuous with a push up bra.

There are chest wall reconstructions for left is excavatum that are done for severe cases but they are big surgeries and probably not worth it in your situation.

Published on Jul 11, 2012


More About Doctor Christopher Pelletiere, MD

Published on Aug 04, 2015

Unfortunately, with pectus excavatum, there are limitations to what can be done. It is true that as the implant gets bigger, it may bring the nipples inward due to the inward rotation of your ribs. However, that being said, you are still very very early in the healing process and have a few months to go. I would just be patient and allow the breasts to relax and settle. Once they have stopped changing, then you will have a better idea of how things look with regards to current size and shape. At that point you can discuss whether any size increase/ projection increase would be possible. I hope this helps.

Answered by Christopher Pelletiere, MD (View Profile)

Unfortunately, with pectus excavatum, there are limitations to what can be done. It is true that as the implant gets bigger, it may bring the nipples inward due to the inward rotation of your ribs. However, that being said, you are still very very early in the healing process and have a few months to go. I would just be patient and allow the breasts to relax and settle. Once they have stopped changing, then you will have a better idea of how things look with regards to current size and shape. At that point you can discuss whether any size increase/ projection increase would be possible. I hope this helps.

Published on Jul 11, 2012


Good morning!
Without seeing your photos, it does make sense that you would be able to achieve a nice result with a larger implant. 300cc High profile is a very narrow implant for someone 5'8", 144 pounds.
Take care

Answered by Don R. Revis, Jr., M.D, F.A.C.S (View Profile)

Good morning!
Without seeing your photos, it does make sense that you would be able to achieve a nice result with a larger implant. 300cc High profile is a very narrow implant for someone 5'8", 144 pounds.
Take care

Published on Jul 11, 2012


Otto Placik, MD

Published on Aug 04, 2015

In some instances, you can wait 4-6 months and undergo a revision with a new implant once the skin envelope has stretched.
In other instances, I have achieved localized fullness of the inner cleavage area using fat transfer for correction of pectus excavatum.

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Answered by Otto Placik, MD

In some instances, you can wait 4-6 months and undergo a revision with a new implant once the skin envelope has stretched.
In other instances, I have achieved localized fullness of the inner cleavage area using fat transfer for correction of pectus excavatum.

Published on Jul 11, 2012


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