Pectus Excavatum Treatment
Overview
Pectus excavatum, sometimes called funnel chest or sunken chest, is a congenital chest-wall condition in which the sternum and adjacent ribs develop inward, creating a depression in the center of the chest.
The degree of indentation varies considerably. For some patients, pectus excavatum is primarily an aesthetic concern, while more pronounced cases may be associated with shortness of breath, reduced exercise tolerance, chest discomfort, or compression of structures within the chest.
The appearance of the chest can also have an important effect on self-confidence and body image. Treatment therefore depends on the severity of the deformity, associated symptoms, anatomy, and the patient's individual concerns.
Understanding Pectus Excavatum
The sternum is connected to the ribs through costal cartilage. In pectus excavatum, abnormal development of the chest wall causes the sternum to sit farther inward than usual.
The condition is generally present from childhood and may become more noticeable during periods of rapid growth, particularly adolescence.
Pectus excavatum can vary from a small localized depression to a deeper and broader chest-wall deformity. It may also be symmetrical or more pronounced on one side.
Depending on severity, patients may experience:
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A visible depression in the center of the chest
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Chest asymmetry
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Prominent ribs or flared lower ribs
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Changes in breast or pectoral symmetry
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Reduced exercise tolerance
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Shortness of breath during physical activity
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Chest discomfort
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Concerns about body image or self-confidence
Many people with mild pectus excavatum do not experience significant physical symptoms.
Evaluation & Treatment Options
Treatment should be individualized because not every patient with pectus excavatum requires surgery.
A clinical assessment considers the depth and shape of the depression, chest symmetry, age, symptoms, and aesthetic concerns. Patients with significant cardiopulmonary symptoms may require additional investigations and evaluation by appropriate specialists.
Depending on the patient's anatomy and objectives, treatment options may include:
Custom Chest Implant
For selected patients whose primary concern is the external contour of the chest, a custom-made implant may be used to fill the depression and create a smoother chest contour.
The implant is designed according to the patient's anatomy and positioned over the underlying chest wall. This approach improves the appearance of the deformity but does not reposition the sternum or correct internal compression.
Chest-Wall Reconstruction
More extensive surgery may be appropriate when structural correction of the chest wall is required.
Certain techniques involve reshaping abnormal cartilage and repositioning the sternum to create a more natural chest-wall contour. The exact procedure depends on the nature and severity of the deformity.
Nuss Procedure
The Nuss procedure is a specialized corrective technique in which one or more curved metal bars are positioned behind the sternum to gradually elevate the depressed chest wall.
The bars generally remain in place for several years before being removed during a second procedure.
Patients requiring structural correction are evaluated to determine whether this type of thoracic surgery is appropriate for their condition.
Choosing the Appropriate Treatment
The best treatment depends largely on whether the objective is cosmetic contour correction or structural correction of the chest wall.
A custom implant can camouflage the external depression without changing the underlying rib cage. Structural procedures, on the other hand, are designed to reposition or reconstruct the chest wall itself.
During consultation, the depth and location of the deformity, chest symmetry, skin and soft-tissue coverage, physical symptoms, and aesthetic expectations are carefully considered before recommending treatment.
Pectus Excavatum Procedure
The exact procedure depends on whether treatment involves a custom implant or structural correction of the chest wall. For cosmetic correction with a custom implant, the procedure generally follows these steps:
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Preoperative Planning: The chest deformity is carefully assessed, including its depth, shape, and symmetry. A custom implant may be designed to match the patient's anatomy.
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Anesthesia & Incision: The procedure is performed under anesthesia. A carefully positioned incision provides access to the depressed area of the chest.
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Implant Placement: A precise pocket is created over the chest wall, and the custom implant is positioned within the depression to restore a smoother, more balanced contour.
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Contour & Symmetry Check: The surgeon evaluates the position of the implant and surrounding tissues to ensure the chest contour appears natural and symmetrical.
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Closure: The incision is carefully closed and dressings are applied. A compression garment may be recommended depending on the procedure.
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Recovery: Swelling, tightness, and discomfort are expected initially. Physical activity is gradually resumed as healing progresses, with follow-up appointments used to monitor the result.
Risks & Possible Complications
As with any surgical procedure, treatment of pectus excavatum carries potential risks. These vary according to the technique and may include:
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Bleeding or hematoma
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Infection
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Fluid accumulation
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Scarring
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Changes in sensation
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Asymmetry or contour irregularities
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Implant displacement or other implant-related complications
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Wound-healing problems
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Anesthesia-related complications
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Need for revision surgery
Structural chest-wall procedures have additional risks that should be discussed with the surgical team before treatment.
Locations
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Suite 402 - 4e étage
Let’s Talk
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Phone
514-845-9898