The concept of “funnel chest” or a “sunken chest” might come as a surprise to many. However, the truth is that Pectus Excavatum is the most common congenital chest wall deformity, one that’s characterised by the “caved in” appearance, hence the name.

Most of the time, most patients seek consultation for this condition due to the “aesthetic concerns,” but it is more than the indentation. In fact, it also inflicts a range of symptoms and discomfort in some cases.

If you are wondering about this developmental disorder and how Pectus Excavatum repair done by an experienced thoracic surgeon such as Dr. Arvind Kumar can transform your life.

What is Pectus Excavatum?

Elaborating on the brief introduction we did, Pectus Excavatum is the most common type of congenital deformity of the chest wall. In this condition, the breastbone (sternum) and adjacent ribs grow abnormally inward, creating a hollow or concave appearance in the chest.

What’s different is the degree of the concavity or the sunken appearance. One thing you need to understand about this condition is that while some cases are “purely cosmetic”, some can inflict uncomfortable symptoms, affecting the patient’s quality of life and their cardiopulmonary function.

The condition is reportedly more common in males than females and the symptoms usually become more “noticeable” during the patient’s early childhood. However, the symptoms can worsen with age.

As for the exact cause of Pectus Excavatum, it is believed that the condition is genetic and is influenced by a hereditary component. It is believed to be linked to abnormal cartilage growth between the ribs and sternum.

Some of the common symptoms associated with Pectus Excavatum are:

• Shortness of breath
• Chest pain
• Reduced stamina
• Palpitations
• Fatigue during exercise, etc.

Keep into consideration that not every patient experiences these symptoms. For some, the condition is asymptomatic.

When Does Pectus Excavatum Require Treatment?

So, when should you consider seeking medical attention for Pectus Excavatum? This is a common question that intrigues a lot of the patients.

The good news about this condition is that not every patient requires surgery. The decision depends on the severity of the deformity and the associated health problems that the patient has.

Usually, treatment is recommended when:

• The deformity causes heart compression, resulting in displacement or decreased cardiac output.
• The lungs are restricted, leading to difficulty in breathing or reduced exercise capacity.
• The patient experiences chronic chest pain or fatigue.
• There is significant psychological distress due to appearance, especially in teenagers and young adults.
• Imaging and diagnostic tests reveal objective impairment of cardiopulmonary function.

In the mild cases with no functional issues, Dr. Arvind Kumar focuses on observation and physiotherapy. However, for moderate to severe cases, surgical correction is considered the option.

How is Pectus Excavatum Diagnosed?

Before recommending surgery, a detailed evaluation is necessary, not only to diagnose the condition but also assess the extent of the deformity in the patient and how it is impacting the body.

During your comprehensive consultation with Dr. Arvind Kumar, you will undergo a series of testing and evaluation to get a clearer picture of your condition and the next steps in the treatment protocol.

Here’s what you can expect:

• Physical examination is the first step in the diagnostic assessment. This is done to measure chest depression and assess posture of the patient.
• CT scan of the chest is also conducted to calculate the Haller Index (ratio of chest width to depth). If the index is greater than 3.25, it often indicates significant severity.
• Since the condition can cause cardiac compression, displacement, or valve-related problems, a 2D ECHO is also performed during the evaluation.
• To evaluate the patient’s lung function and efficiency, pulmonary function tests are also conducted.
• You will also undergo exercise testing to assess stamina and oxygen uptake during physical activity.

The reason why a thorough diagnostic evaluation is recommended for Pectus Excavatum is to ensure that the patients who need surgery are correctly identified and the surgical plan is personalised before it’s too late.

What are the Treatment Options for Pectus Excavatum?

Depending on the patient’s severity and their condition, there are two treatment routes for the condition – Surgical and Non-Surgical.

Non-surgical management is usually recommended to patient with mild sunken appearance and no worrying symptoms. Surgery, on the other hand, is recommended when the condition is interfering with other major organ functions.

1. Non-Surgical Management

If you have a mild case of Pectus Excavatum, the first step in your treatment protocol is observation. This means that the doctor will conduct regular monitoring and ensure that the condition doesn’t worsen over time. If it does, a modified treatment approach is taken.

Sometimes, physiotherapy and posture correction is also recommended. These include exercises that strengthen the chest and back muscles and improve the overall appearance and lung function of the patient.

Also, for patients with mild and flexible chest deformities, especially in children and adolescents, vacuum bell therapy is also done. It involves the use of a suction device to pull the sternum out and improve the appearance of the deformity.

2. Surgical Management

When highlighting the most definitive form of Pectus Excavatum repair, surgical approach remains a superior choice. There are two primary techniques, which include:

Nuss Procedure

This is a minimally invasive procedure wherein a curved metal bar is inserted under the sternum through small incisions. The bar’s main function is to push the chest outward, correcting the deformity. It is left in place for 2–3 years before removal.

The main reason why it is so popular is because of its minimally invasive nature, smaller incisions and quicker recovery. However, it is usually recommended for adolescents and younger patients with flexible chest walls.

Ravitch Procedure

This is a type of open surgery that involves removal of abnormal cartilage and repositioning of the sternum, sometimes with the use of support bars.

For patients with complex and severe deformities, this is the most commonly recommended repair approach. Also, adult patients with rigid chest walls are more viable for this technique. Patients with a history of failed Nuss procedure also benefit from this surgery.

How is the Recovery Like after Pectus Excavatum Repair?

Once you have undergone the surgical procedure to fix the deformity, a common follow-up question is, “How long will the recovery be? Will it be painful and uncomfortable?”

If you are plagued with similar thoughts, let us clarify all the prospects of healing and recovery after your Pectus Excavatum repair. The hospital stay after the surgery is usually between 4-7 days, depending on the condition of the patient.

Here’s what you can expect during the recovery period:

• Postoperative pain is quite common but can be managed with advanced pain-control techniques, including epidurals or patient-controlled analgesia.
• You will be advised to avoid strenuous activity, contact sports or lifting heavy weights for several months after the surgery, irrespective of which particular repair you are undergoing, Nuss or Ravitch.
• Regular follow-up visits after the surgery are mandatory, primarily to monitor healing and keep an eye on the bar position if you have undergone Nuss procedure.
• As for returning to your daily routine, most patients can return to school or work within 2-3 weeks but for exercise and other physical activities, you’d need to wait for up to 8 weeks.

After your surgery, Dr. Arvind will provide you a detailed rundown of the dos and don’ts and the recovery tips, ensuring that you don’t have to worry about pain, discomfort or complications down the line.

What are the Long-Term Results with Pelvis Excavatum Repair?

The reason most patients choose to undergo Pelvic Excavatum repair is to improve their symptoms and have a better quality of life.

Some of the long-term results and improvements you can expect are:

• Better exercise tolerance and stamina.
• Reduced or eliminated chest pain and shortness of breath.
• Corrected posture and chest symmetry.
• Boosted confidence and self-esteem due to improved appearance.
• Enhanced cardiac and pulmonary function in severe cases.

The Nuss bar is removed after 2–3 years, while results from the Ravitch procedure are permanent. With proper follow-up, recurrence is extremely rare.

Living with Confidence After Repair!

Living with Pectus Excavatum can be a physical and emotional challenge. However, with the advancements in surgical techniques, particularly the minimally invasive Nuss procedure, a safe and effective repair is now a reality for many.

Correcting the deformity can not only alleviate physical symptoms like shortness of breath and chest pain but can also have a transformative impact on self-confidence and overall well-being.

Dr. Arvind Kumar is an experienced thoracic surgeon, offering attentive care to patients diagnosed with Pectus Excavatum. Book a consultation today!

FAQs

What is the age for pectus excavatum surgery?

The ideal age is during adolescence (12–16 years), when the chest wall is still flexible. However, adults with severe deformities can also benefit from surgery too.

Are the results permanent?

Yes. Once corrected, the results are typically permanent. In the Nuss procedure, the corrective bar is removed after 2–3 years, while the Ravitch procedure provides permanent structural correction.

Can adults undergo pectus excavatum repair?

Yes. While outcomes are best in adolescents, adults with severe deformities or symptoms can also benefit. Usually, Ravitch procedure is the more recommended route for adults.