We present an endoscopic approach for the reconstruction of pectus excavatu
m with a custom silicone implant. The procedure incorporates endoscopic tec
hniques to facilitate dissection of an extensive subcutaneous pocket throug
h a 6-cm Chevron skin incision 8 cm below the level of the xiphoid. The inc
ision is designed based on the size, shape, and flexibility of the custom i
mplant and the configuration of the chest wall deformity. A superiorly base
d rectus abdominis anterior fascial sheath flap then is elevated up to the
caudal-most margin of the implant, creating a sling below the implant, thus
stabilizing its position and preventing direct communication with the over
lying skin incision. In our patient, the endoscope permitted insertion of t
he custom implant while minimizing the length of incision. The cosmetic res
ult using a minimally invasive approach to assist with the dissection was a
cceptable, and the morbidity and scarring were minimized.