Pectus excavatum is the most common congenital chest wall deformity, characterized by an abnormal inward growth of the sternum and ribs, creating a noticeable “sunken chest” appearance. In moderate to severe cases, the sunken breastbone may compress the heart and lungs, potentially limiting their function. Effective treatment, whether non-surgical or surgical, requires precise diagnostic evaluation and specialized procedural expertise. The pathway to correction involves a coordinated team of medical professionals.
Initial Medical Evaluation and Referral
The first point of contact for a patient concerned about a chest wall abnormality is usually the Pediatrician or a Primary Care Physician. This provider conducts a physical examination and takes the patient’s history, recognizing the characteristic funnel shape of the chest. If the physician suspects the condition is more than cosmetic, the patient is promptly referred for a functional assessment.
Specialists like a Cardiologist and a Pulmonologist are brought in early to determine the extent of organ compression and functional limitation. A Cardiologist assesses the heart using tests like an echocardiogram, checking for displacement or compression against the chest wall. The Pulmonologist evaluates lung capacity through pulmonary function tests (PFTs) and may perform a cardiopulmonary exercise test to measure how the heart and lungs perform under physical stress.
A Computed Tomography (CT) scan is a standard diagnostic tool used to measure the severity of the indentation, providing the Haller index. This index is the ratio of the chest’s transverse diameter to its anterior-posterior diameter. A score greater than 3.2 often indicates a severe deformity and serves as a common criterion for surgical intervention, providing objective data for referral to surgical specialists.
Specialists Who Perform Surgical Repair
The definitive correction of pectus excavatum is performed by specialized surgeons, primarily Thoracic Surgeons and Pediatric Surgeons. These specialists have the advanced training required to reconstruct the chest wall and relieve pressure on internal organs. The choice between them often depends on the patient’s age and the specific institutional expertise available.
Pediatric Surgeons commonly manage these cases, especially when the patient is an adolescent, which is the typical age range for surgical repair. They are highly experienced in the minimally invasive Nuss procedure. This technique involves placing a customized curved steel bar beneath the sternum to push it outward into a corrected position.
Thoracic Surgeons, specializing in the chest, may also perform the Nuss procedure and are often preferred for adult patients. In adults, the chest wall is less flexible, making surgical correction more technically demanding. This may necessitate the traditional open repair, known as the Ravitch procedure, which involves removing deformed costal cartilage and repositioning the sternum.
Many major medical centers now have integrated chest wall deformity programs where Pediatric and Thoracic Surgeons collaborate. This ensures the most appropriate surgical technique is selected based on the patient’s chest geometry and rigidity. Their expertise also includes detailed pre-operative planning and the selection of advanced pain management techniques like cryoablation, which temporarily freezes nerves for post-operative pain relief.
The Comprehensive Care Team
Beyond the surgeons, successful long-term management relies on a multidisciplinary team of supporting specialists. Physical Therapists play a continuous role, guiding the patient through targeted exercises to improve posture, strengthen core muscles, and enhance diaphragmatic breathing mechanics. This training supports the new chest structure and maximizes cardiorespiratory function.
For patients with mild to moderate deformities who opt for non-operative management, an Orthotist may prescribe a vacuum bell device. This device is a suction cup placed on the chest that uses negative pressure to gradually lift the sternum over time. The Orthotist ensures the device fits correctly and provides instructions for its consistent use, which is necessary for effective remodeling.
Mental health professionals, such as Psychologists or counselors, are an important part of the care team, particularly for adolescents. Pectus excavatum can significantly impact self-esteem and body image, potentially leading to social anxiety and withdrawal. These specialists provide support to address the psychosocial challenges associated with the deformity, ensuring the patient’s emotional well-being is prioritized alongside the physical correction.