Board-certified thoracic surgeon, Dr. Rachel Medbery, treats a condition known as pectus excavatum, a chest wall deformity that causes a person’s breastbone to sink inward. It’s also referred to ‘funnel chest’ and is more common in boys than girls. Pectus deformities are the most common chest wall defect and occur in approximately 1 of every 150-1,000 births, according to the National Library of Medicine.
Dr. Medbery says that visually, it looks like a person’s chest is concave. It is a congenital condition and caused by an overgrowth of cartilage where the ribs come together and meet the breastbone. When that cartilage growth ‘goes into overdrive’, it can cause the breastbone to sink inward.
Severe cases of the disease can impact a patient’s heart and lung function, but even mild cases can make a person feel insecure about their appearance.
What are the symptoms of pectus excavatum?
Patients with pectus excavatum will complain of chest pain and shortness of breath, especially during exercise. Some patients say they feel like they can’t get a full breath and may even feel faint. This is due to the chest caving in and pressing on their lungs and heart, which can cause extreme discomfort.
How is pectus excavatum treated?
Fortunately, surgery can correct the deformity, but Dr. Medbery warns that it is a complex one. For this reason, she does not recommend it for aesthetic reasons only. But for patients with shortness of breath and chest pain with exercise, she says repairing the chest wall can make a significant, positive impact.
There are two approaches to repair pectus excavatum. The first surgical treatment is known as the Nuss procedure where a thorascope, or small camera, is used to see inside the chest cavity during the repair. This technique avoids a large incision and having to remove the cartilage. Instead, the surgery is done through small incisions. A “pectus” bar is inserted into the chest to support the sternum. The bar is made of titanium and comes in various lengths. Dr. Medbery selects a length based on the patient’s chest size and says it’s like putting braces on your teeth. Over time, it encourages the breastbone to grow outwards. This is not a permanent bar and is typically removed after about two years.
For those who are done growing, a Ravitch procedure may be done. This involves a total chest wall reconstruction. It’s a six hour surgery where surgeons remove all of the overgrown cartilage and reshape the sternum with a special plate and muscle reconstruction. This leaves patients with a normal appearing chest and more importantly, it allows their lungs and heart to function properly.
What is the recovery process like with pectus excavatum surgery?
Dr. Medbery says most patients will recover in about three months and must take special care in protecting their chest wall, including not riding in the front seat of a car (an airbag deployment would undo the corrective surgery) and wearing a special brace.
Pain control for pectus excavatum surgery includes:
- Muscle relaxers
- Nerve blocks
- Anti-anxiety medicine
- Some narcotics
For more information on pectus excavatum, please visit ctvstexas.com or call us at (512) 459-8753 to schedule an appointment. Don’t forget to follow us on Facebook and Instagram for the latest CTVS news.