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Per Hedén, Response to Letters to the Editor Regarding “An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment”, Aesthetic Surgery Journal, Volume 39, Issue 7, July 2019, Pages NP305–NP306, https://doi.org/10.1093/asj/sjz135
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I want to thank Drs Chavoin and Morandi for their letters to the editor1,2 regarding our publication “An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment.”3
I do agree with the comments by Drs Chavoin and Morandi that both custom-made implants and fat grafting are very useful tools for the correction of nonfunctional pectus excavatum (PE). In fact, both of these methods would be my first suggestions for patients seeking correction of these deformities, and I utilize both methods commonly, even in combination, to optimize the outcome. The goal of our study is not, however, to discredit these surgical techniques, but rather to evaluate the potential safety and effectiveness of hyaluronic acid (HA) for PE correction. To our knowledge, no other study with this aim has been performed.
The alternative of utilizing custom-made implants is very appealing, but it should be acknowledged that recovery, even if very acceptable for most patients, is much longer and more difficult than after a simple injection of HA regarding when the patent can return to performing daily activities. Also, custom-made implants leave scars that can be completely avoided with an injection. In addition, a custom-made implant is a very expensive product, especially if it is performed with 3-dimensional computed tomographic data and computer-aided prosthetic manufacturing. It is true that pricing of HA injection is not discussed in our article and that repeated injection of larger volumes could be costly. Once again, comparisons of the use of HA with other techniques was not a goal for this article. Chavoin et al1 question the use of HA in women with PE, and although it is true that the HA does not have an indication for breast augmentation, this is explained by the problem of performing mammography in which HA can obscure the mammary gland. In PE treatment, HA should not be injected into the mammary gland.
