Precision chest sculpting: 3D-customized silicone implants and computer-aided design assisted reconstruction for pectus excavatum - a single center experience.

Pectus excavatum correction in adults is often pursued for functional and aesthetic reasons, yet modified Nuss and Ravitch procedures may be invasive and can leave residual anterior chest wall contour deformities. We report a single-center retrospective consecutive case series of aesthetic chest wall correction using patient-specific silicone implants designed with computed tomography (CT)-based three-dimensional (3D) computer-aided design (CAD), with descriptive assessment of postoperative patient-reported and morphological outcomes. Between 2018 and 2024, seven adults underwent CAD-assisted correction at a tertiary referral center (mean age 31.3 ± 11.0 years). Five had previously undergone modified Nuss or Ravitch repair. The primary outcome was postoperative chest-appearance satisfaction, assessed using a six-item questionnaire derived from the modified Nuss questionnaire and scored on a 5-point Likert scale. A mean overall satisfaction score (range 1-5) was calculated. As a secondary outcome, postoperative chest wall morphology was documented using upright 3D surface models (VECTRA WB360) for qualitative illustrative assessment of contour correction. At a mean follow-up of 3.2 ± 1.9 years, patient-reported outcome data were available for five patients and postoperative 3D surface models for four. Mean overall satisfaction was 3.3 ± 0.8 (range 2.3-4.1), with higher satisfaction for chest appearance when clothed than unclothed (4.0 ± 1.0 vs 2.8 ± 1.48). Qualitative 3D assessment suggested restoration of sternal projection and improved chest wall symmetry in all imaged patients. One patient developed postoperative seroma followed by infected hematoma requiring implant explantation. In this retrospective case series, available follow-up data suggested qualitative contour improvement and generally favorable patient-reported satisfaction, but also a non-negligible complication risk. Findings should be interpreted cautiously given the small sample, incomplete follow-up, and descriptive design.