Pectus excavatum is a chest wall deformity characterized by an inward depression of the sternum, also known as the breastbone. This condition gives the chest a sunken or caved-in appearance. It is the most common congenital chest wall abnormality, affecting approximately 1 to 8 individuals per 1,000, and is observed more frequently in males. While sometimes noticeable at birth, the indentation often becomes more pronounced during adolescent growth spurts.
Understanding Non-Surgical Options
Non-surgical approaches for pectus excavatum are considered for milder cases or as complementary treatments. Vacuum bell therapy involves placing a silicone or rubber cup over the chest depression. A pump then creates a vacuum, lifting the sternum and ribs outward. This continuous negative pressure aims to reshape the chest wall over time.
Vacuum bell therapy requires consistent daily use for several hours over an extended period. While effective for some individuals, especially adolescents with flexible chest walls, it does not offer an immediate or permanent correction. Physical therapy and exercises can support treatment by improving posture and strengthening chest muscles. These exercises do not directly correct the sternal depression but can alleviate discomfort and improve body mechanics.
Surgical Correction Methods
Surgical intervention offers definitive solutions for pectus excavatum, particularly for moderate to severe cases impacting cardiac or pulmonary function or causing cosmetic concerns. Two surgical techniques are used: the Nuss procedure and the Ravitch procedure. These procedures aim to restore a normal chest contour and alleviate internal organ compression.
The Nuss procedure is a minimally invasive technique involving inserting a curved steel bar behind the sternum. Small incisions are made on each side of the chest, through which the bar is threaded with the aid of a thoracoscope. The bar is then rotated to push the sternum outward, correcting the depression. This procedure is preferred for younger patients with more flexible chest walls and is associated with smaller scars and a quicker initial recovery compared to open surgery. The bar remains in place for two to four years to allow the chest wall to remodel before surgical removal.
The Ravitch procedure is an open surgical technique involving a larger incision down the center of the chest. During this procedure, abnormal cartilage connecting the ribs to the sternum is resected, and the sternum is repositioned. A small strut or mesh may be used to support the sternum. This approach allows for direct visualization and reshaping of the chest wall, making it suitable for older patients, those with asymmetric deformities, or individuals who have undergone previous chest surgeries. Though it involves a more extensive recovery, it provides a durable correction.
Life After Treatment
Recovery following pectus excavatum treatment involves several phases. Immediately after surgery, pain management is a focus, managed through epidural catheters or patient-controlled analgesia. Patients remain in the hospital for a few days for monitoring and pain control.
Activity restrictions are important during initial recovery to allow the chest wall to heal. For Nuss procedure patients, strenuous activities, heavy lifting, and contact sports are restricted for three to six months to prevent bar displacement. Full recovery and return to all activities can take up to a year. Ravitch procedure patients have similar activity restrictions and timelines for gradual return to normal activities as the sternum and surrounding tissues heal.
Physical therapy supports recovery by helping restore range of motion, improve posture, and strengthen core muscles. Regular follow-up appointments with the surgical team are essential to monitor healing, assess correction stability, and plan for bar removal if a Nuss procedure was performed. Bar removal occurs two to four years after insertion in a separate, less invasive procedure.
Navigating Your Treatment Journey
Deciding on appropriate pectus excavatum treatment requires professional guidance. The first step involves consulting with a medical professional, such as a thoracic surgeon or a specialist in chest wall deformities. These specialists can assess the condition’s severity and its impact on heart and lung function.
Diagnostic evaluations, including imaging studies like CT scans, measure the sternal depression and check for internal organ compression or displacement. Treatment decisions consider deformity severity, symptoms like shortness of breath or chest pain, and cosmetic concerns. Discussion with a specialist leads to an individualized treatment plan tailored to the patient’s needs.