Treating Sunken Chest Offers Kids Physical & Emotional Benefits

Pectus excavatum – also called sunken chest or funnel chest – is a common chest deformity that affects one out of every 300 to 400 children. The condition causes some of the ribs to grow inward, which can impact heart and lung function. Additionally, the indented appearance of the chest may negatively influence a child’s body image and self-esteem and can lead to depression.

In most mild cases, pectus excavatum does not require surgery. However, surgical intervention can lead to significant functional and cosmetic improvements in more severe cases. Edward Barksdale, MD, chief of pediatric surgery at University Hospitals Rainbow Babies & Children’s Hospital, says that surgery to correct pectus excavatum can be life-changing for patients, giving them back their confidence and improving their quality of life.

Symptoms and Diagnosis

Although pectus excavatum is a congenital deformity that children are born with, symptoms may not become apparent until their growth spurt during puberty. Children with pectus excavatum may start to experience symptoms such as chest pain, shortness of breath, fainting or heart palpitations, or they may only notice the indented appearance of the chest. This indention may become progressively worse as the child continues to grow.

After pectus excavatum is diagnosed using imaging scans such as magnetic resonance imaging (MRI) or computed tomography (CT), a pediatric surgeon will rate the deformity from mild to extreme. The more severe the deformity, the more likely surgical intervention may be recommended.

Dr. Barksdale recommends that families meet with a surgeon early once pectus excavatum has been diagnosed. This doesn’t necessarily mean surgery is needed – but it can be important to help educate the patient and their parents on the options available. Pre-surgical counseling is also helpful to set appropriate expectations and to empower patients and families to make the decision that is right for them, says Dr. Barksdale.

“We want every child who comes to us to feel like they are in charge of their own body,” says Dr. Barksdale. “We work carefully with families to find what makes sense for them and their kids.”

Two Surgical Approaches

There are two surgical procedures that can be used to correct pectus excavatum: the modified Ravitch procedure and the Nuss procedure. Both procedures involve inserting a metal bar near the deformity to correct the indentation. The Ravitch has been around longer and is a more traditional open surgery. The Nuss procedure is a minimally invasive surgery that uses two small incisions to insert a custom-made bar at the site of the indent. This bar will slowly push the sternum outward into a more normal position. With both procedures, the bar will be removed about three years after the initial surgery.

Even though the Nuss procedure is less invasive, it has traditionally been the more painful of the two procedures. However, surgeons have recently introduced the use of cryoblation during surgery, which greatly reduces post-operative pain. With cryoblation, some of the nerves around the ribs and sternum are frozen before the bar is inserted. Dr. Barksdale says the technique is so effective for pain control that most patients only need to stay in the hospital two to three days, down from the average of about a week before cryoblation was routinely used.

This improved pain control, coupled with the minimally invasive approach, less blood loss and shorter hospital stay, has made Nuss the more popular and preferred procedure for most patients.

Significant Improvements After Surgery

Dr. Barksdale says most families are very pleased with their outcome after surgery – both physically and psychologically. Improvement in heart and lung function can help children get back to activities and sports they previously enjoyed but couldn’t participate in before surgery. They often report a significant improvement in self-esteem and body image after the indentation has been corrected, becoming more confident in their bodies and no longer avoiding mirrors, bathing suits or baring their chest.

Dr. Barkdale says it is so rewarding to see the relief in a parent’s eyes when they see that surgery has gone well, and when they see their child’s chest for the first time after the procedure.

“We want to create a new narrative for patients,” says Dr. Barksdale. “Improving function and appearance and increasing their self-confidence can help them achieve this.”

Related Links

The pediatric surgeons at UH Rainbow provide expert chest wall reconstruction for conditions such as pectus excavatum, as well as surgical care for a wide range of conditions, both common and complex.