Aesthetic outcomes after surgical repair of pectus excavatum in females: Differences between patients and professional evaluators

Abstract

Background: Pectus excavatum is less common in females than in males, and it often aggravates a coexistent breast asymmetry. We conducted a study comparing female patients' versus medical professionals' evaluation of pectus excavatum repair to assess differences in aesthetic outcome ratings. Moreover, we evaluated the influence of surgical correction on patients' self-perception.

Methods: Of 30 female patients who were initially screened, 18 patients (mean age, 20 years) who underwent bar removal after surgical correction of pectus excavatum deformity participated in the survey (60%). They completed a questionnaire rating their appearance before and after surgery and responded to a psychological questionnaire about the changes that they had experienced. The mean interval between pectus bar removal and evaluation was 28 months. Standardized preoperative and postoperative patient photographs were evaluated using the same questionnaire by a panel of medical professionals and students (n=24) and the results were compared.

Results: Patients rated their preoperative deformity as more severe than the other evaluators, revealing the significant impact of the deformity on patients' self-perception. Postoperatively, patient and professional evaluations were much better than before and were very similar. The psychological evaluation showed a clear improvement in well-being. The ratings of the medical professionals were not influenced by their degree of medical education.

Conclusions: Surgical correction of pectus excavatum in female patients positively influences body perception and psychological well-being. It should therefore not be considered as a merely aesthetic correction, but as an important procedure to restore a patient's self-perception.

Keywords: Female; Funnel chest; Self concept; Thoracic surgical procedures.

Fig. 1.. Results of questionnaire 1

Preoperative (A) and postoperative (B) evaluation by patients and medical professionals. NAC, nipple-areolar complex.

Fig. 2.. Pre- and postoperative standardized photo documentation

Representative images of a patient in the preoperative (A-C) and postoperative (D-F) setting. Simultaneously with pectus bar removal, reduction mammaplasty and reconstruction of the inframammary fold was performed.