Breast Augmentation with Chest Wall Deformity Fix

Patient Overview

• Patient: Ceran

• Age: 31 years old

• Gender: Female

• Procedures: Breast augmentation with silicone implants (dual plane technique), fat grafting to chest wall for congenital bone deformity correction

• After photos taken at: 3 months post-surgery

• Location: Istanbul, Turkey

  
  

When Breast Augmentation Reveals a Deeper Problem

Most patients who consult for breast augmentation are focused on a single goal: fuller, more shapely breasts. The consultation begins with implant discussions and ends with a surgical plan. But occasionally, the preoperative assessment uncovers an underlying anatomical issue that standard augmentation alone would not only fail to address but could actually make more visible. Ceran, a thirty-one-year-old patient of Dr. Cem Berkay Sinaci, presented with exactly this scenario — a congenital chest wall deformity along the midline of her sternum that required correction alongside her breast augmentation to achieve a truly harmonious result.

Dr. Sinaci, a European board-certified plastic surgeon (FEBOPRAS) and active member of ISAPS and ASPS, identified this bone defect during Ceran's physical examination and recognised that placing implants without addressing the chest wall irregularity would create a visually incongruent outcome. The breasts might look beautiful individually, but the depression between them would draw the eye and undermine the overall aesthetic. The solution was to combine breast augmentation with targeted fat grafting to the midline defect — two procedures working together to solve a problem that neither could solve alone.

What Congenital Chest Wall Deformity Means

Congenital chest wall deformities encompass a spectrum of conditions where the sternum, ribs, or cartilage develop abnormally during foetal growth and childhood. The most widely known are pectus excavatum — a sunken sternum — and pectus carinatum — a protruding sternum. But milder variants exist that affect only a portion of the chest wall, creating localised depressions, asymmetries, or contour irregularities that may go unnoticed until a surgical procedure brings the area under close scrutiny.

Ceran's deformity involved the midline of the chest — the area over the sternum between the two breasts. This region, which forms the foundation of the cleavage area, normally presents as a smooth, gently contoured surface. When a bone defect creates a depression or irregularity in this zone, it disrupts the visual continuity between the breasts, making even a technically perfect augmentation appear incomplete.

Many patients live with mild chest wall irregularities without awareness. The natural breast tissue, clothing, and the absence of close clinical examination mean that these subtle deformities never come to attention. It is often the breast augmentation consultation — with its detailed physical examination of the entire chest — that reveals conditions the patient herself may not have recognised. Dr. Sinaci's thorough preoperative assessment protocol ensures that these findings are identified before surgery, not discovered afterward when they become more conspicuous against the enhanced breast contour.

Fat Grafting: The Ideal Solution for Bone Contour Defects

Correcting a midline chest wall depression presents a unique surgical challenge. The defect is bony in origin, meaning the contour irregularity lies at the deepest structural level. Building up this area requires a material that can be placed directly over the bone surface, shaped precisely to fill the depression, and integrated permanently into the surrounding tissue.

Fat grafting meets all of these requirements. Harvested from a donor site on the patient's own body — typically the abdomen, flanks, or thighs — the fat is processed and purified before being injected in small, meticulously placed aliquots over the sternal defect. Each injection deposits a thin layer of fat cells, building volume gradually until the depression is level with the surrounding chest wall.

The advantage of autologous fat over synthetic fillers or implants for this application is biological integration. The transferred fat cells establish a blood supply from the surrounding tissue and become living, permanent components of the chest wall soft tissue. They feel natural to the touch, move naturally with breathing and body position, and are invisible on the surface. There is no palpable edge, no risk of extrusion, and no foreign material to maintain or replace.

For Ceran, the fat grafting added only a small volume to the midline — enough to smooth the contour deficit — but its impact on the overall result was disproportionately significant. The smooth, continuous surface between her augmented breasts creates the visual unity that the bone defect would have interrupted.

Why the Dual Plane Was Selected

Ceran's breast augmentation component utilised the dual plane technique, a decision based on her specific tissue characteristics at thirty-one. The dual plane provides upper pole muscle coverage for implant camouflage while releasing the lower muscle fibres to allow natural lower pole expansion — the same mechanical advantages that make this technique versatile across a wide range of patient anatomies.

In Ceran's case, the dual plane offered an additional practical benefit related to the simultaneous fat grafting. Because the lower pectoralis fibres are released in the dual plane approach, the surgical access allows assessment and treatment of the midline chest wall during the same operative session. The fat grafting to the sternal area could be performed with direct visualisation of the anatomical landmarks, ensuring precise volume placement over the bone defect.

This combined approach — addressing the breast volume and the chest wall contour through coordinated techniques — exemplifies the philosophy Dr. Sinaci developed during his fellowship with the internationally renowned plastic surgeon Raul Gonzalez in Brazil. Brazilian aesthetic surgery culture emphasises treating the entire aesthetic unit rather than isolated components, recognising that the beauty of any result depends on the harmony between adjacent structures, not just the perfection of any single element.

The Three-Month Result: Assessing Two Corrections Simultaneously

Ceran's three-month photographs allow evaluation of both the breast augmentation and the fat grafting as mature results. By three months, the dual plane implants have completed their settling process — the upper pole has softened, the lower pole has filled, and the breast shape has reached its definitive form. The capsule has matured, and the breast moves naturally with body position.

The fat graft to the midline has also reached a stable endpoint by three months. The biological process of fat graft survival follows a specific timeline: in the first weeks after transfer, the injected fat cells must establish a new blood supply from the surrounding tissue through a process called neovascularisation. Fat cells that successfully revascularise survive permanently; those that do not are gradually reabsorbed by the body. By three months, this selection process is complete. The volume that remains at the three-month mark represents the permanent correction.

Dr. Sinaci accounts for this expected partial reabsorption during the initial fat grafting by slightly overcorrecting the defect. The volume injected exceeds the volume needed for the final correction, anticipating that a percentage of the transferred cells will not survive. The three-month assessment confirms whether the surviving graft volume has produced adequate correction or whether a small touch-up session might further optimise the midline contour.

The Holistic Assessment That Makes the Difference

Ceran's case underscores a principle that separates comprehensive surgical planning from a purely procedural approach. A surgeon focused exclusively on breast augmentation might have placed implants and sent the patient home with fuller breasts but an uncorrected — and now more noticeable — chest wall deformity. The enhanced breast volume would have framed the midline depression rather than being complemented by a smooth surface.

Dr. Sinaci's decision to address both the breast volume and the chest wall contour in a single session produced a result where neither correction is visible as a separate intervention. The breasts appear naturally fuller, and the chest between them appears naturally smooth. The patient sees a unified improvement rather than a breast augmentation sitting awkwardly above an anatomical irregularity.

This holistic assessment — examining not just the breasts but the entire chest wall, the skeletal framework beneath it, and the relationship between all visible structures — is what allows a surgeon to anticipate problems that the patient may not have identified and solve them proactively. For Ceran at thirty-one, this approach produced a result at three months that addresses every component of her aesthetic concern in a single recovery period.

Combined Procedures in Istanbul

For patients with anatomical variations beyond simple breast volume deficiency, Ceran's case demonstrates that breast augmentation can be combined with complementary procedures to achieve a complete result. Congenital chest wall deformities, rib asymmetries, and soft tissue irregularities do not need to be accepted as permanent limitations — they can be addressed simultaneously with augmentation when identified during a thorough preoperative assessment. Her three-month before and after photographs show the value of treating the complete aesthetic picture rather than a single isolated concern, producing a result where every element contributes to a natural, harmonious outcome.