Reconstruction of the thoracic (Chest) wall

The chest wall is integral to life and has an intrinsic aesthetic value as well. The muscles involved in breathing are attached to the chest wall and are adversely affected where the latter is diseased or removed. The advent of reconstructive surgical techniques of the chest wall has now permitted modern and advanced methods of surgical restoration of form and function, and this is a rapidly evolving field within reconstructive plastic surgery. Picasso Plastic Surgery is pleased to be among the innovators and early adopters in this field and is able to deliver care in this niche area.

How do chest wall defects arise?

There are two settings in which chest wall defects arise:

  • Traumatic rib fractures. This is usually as a result of falls or accidents.
  • Chest tumors that require resection of the chest wall for tumor access or tumor excision.

Chest (Thoracic) Wall Reconstruction Surgery for Chest Tumours & Rib Fractures

How were they traditionally treated?

Rib fractures are often managed with only analgesia and waiting for natural healing of the ribs. Traditionally, this is thought to require about 6 weeks. Despite analgesia, many of such individuals suffer from chronic pain as the ribs are in constant motion due to breathing. A significant proportion of ribs may not heal in the correct position, or are non-healing due to their constant movement and this contributes to long term pain, difficulty with deep breathing and exercise and delayed return to work.

Individuals with chest tumors requiring resection often have a significant portion of their chest wall removed for access to or resection of the tumor. In the past, following tumor resection, the resected chest wall is discarded, and these individuals require prolonged ICU stay until recovery of the breathing mechanics, or are reconstructed with biological cement. Biological cement is stiff and inelastic and poorly approximates the chest wall. It may lead to long term pain, erosion and extrusion.

New techniques of chest wall reconstruction reliably and optimally restores the chest wall mechanics and enables the resection of large portions of the chest wall for tumor excision that were not previously possible.

Reconstruction of the chest wall: restoring life and function

Together with outstanding thoracic surgery colleagues, Dr Yeo has co-developed some interesting and novel techniques for chest wall reconstruction that produce rapid and optimal functional recovery.

Individuals with multiple rib fractures or flail rib segments (ribs broken in 2 or more places) may undergo operative stabilization of the broken ribs for superior functional outcome and shorter recovery periods. This is performed using new-generation titanium plates that closely simulate the biological properties of ribs. Together with partnering thoracic surgeons, minimally-invasive techniques of rib fixation are possible with the use of small incisions, endoscopic techniques for identification of the fracture sites and surgical fixation. This newly-developed endoscopic technique further minimizes pain and shortens the recovery time while providing good functional improvement.

Individuals with intrathoracic tumors may now safely undergo surgery with a greatly reduced postoperative mechanical ventilation duration. While the tumor surgery is being performed, the chest wall is reconstructed on a side table using the ribs resected for access to the tumor. At the end of the tumor resection, the recreated chest wall is replaced into the chest and fixed with titanium implants. This provides an optimal like-for-like reconstruction.

The Picasso Advantage

Dr Yeo has had the privilege of working with esteemed thoracic surgery colleagues and co-developed some novel chest wall reconstruction techniques. As innovators and early adopters of modern chest wall reconstruction, they often speak and demonstrate at lectures and courses on these techniques. Chest wall reconstruction is currently a rapidly evolving field within reconstructive surgery. Dr Yeo is pleased to be one of the few providers of these chest wall reconstruction techniques.

Dr Matthew Yeo, Picasso Plastic Surgery, Team Nurses, Singapore Aesthetic & Cosmetic