Breast cancer surgery in the presence of previous reconstruction for pectus excavatum has not been reported. Such a case is described where simultaneous chest wall resection was undertaken because of fibrous tissue distortion mimicking malignant infiltration. Furthermore, postoperative adhesions necessitated opening the pleural lining during rib resection. This resulted in recurrent pleural effusion from axillary lymphatic leakage that required thoracocentesis. Breast surgery in these circumstances has to be performed with care.