Autologous Lipotransfer for Pectus Excavatum Correction

Extract

It was with great interest that we read the article “An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment” by Heden and Sinna,¹ and we appreciate this minimally invasive, however temporary option for aesthetic correction of pectus excavatum (PE) deformities.

Whereas in the past plastic surgeons mostly used custom-made silastic implants for subcutaneous (extrathoracic) corrections, PE repair currently concentrates on more functional treatment, namely the minimally invasive repair of PE, the hybrid modified open video- endoscopically assisted repair of PE, or the Ravitch technique² as thoracic wall remodeling interventions. However, an extrathoracic, subcutaneous correction can be sufficient in mild deformities and profits from low morbidity.

To correct surface irregularities and contour impairment in general, fillers have proven to be a minimally invasive option. For this purpose, hyaluronic acid is a highly valuable tool in cosmetic facial treatment but is also used in other body regions. As a recombinant, biological substance, modern hyaluronic acid fillers are resorbable and thus provide correction for a limited period only. In their paper, the authors reported a resorption rate of only 42% after 24 months.¹ However, we are convinced that autologous lipotransfer is a valuable alternative, because it provides a very permanent result compared with the authors’ method employing an absorbable filler. We have applied this technique in PE patients for the correction of minor deformities and experienced stable long-term results with high patient satisfaction. In our opinion, such lipotransfer is also a rewarding option for the treatment of residual deformities (Figure 1) after correction by skeletal remodeling surgery³ and particularly in females for unilateral breast augmentation in the case of additional breast asymmetry.⁴ Furthermore, fat grafting is a well-established technique in aesthetic and reconstructive surgery that involves low complication rates³ as well as high acceptance among patients. Moreover, the results remain stable after 3 to 6 months, although resorption rates depend on various factors.⁵ In general, more than one session is needed to reach the desired result and fulfil the individual patient’s requirements. One of the concerns met in the presternal area is the fact that there is only a thin layer of subcutaneous tissue, and the strong adhesions of the skin to the sternal periosteum and pectoralis muscle fascia might impede injection of either fat or synthetic fillers in larger volumes during the first session.³ It is well known that high pressure and subsequent low oxygen levels are associated with a higher resorption rate of the fat graft and should therefore be avoided.⁵