It’s a common problem. But many kids and their parents don’t talk about it. In fact, chest wall defects are common congenital abnormalities occurring in up to one in 300 live births. The condition is about four times more likely to occur in boys than in girls. Until now, an invasive, often painful surgery was the only option for children and teenagers facing this problem.

Overland Park Regional Medical Center offers surgical and non-surgical interventions for chest wall deformities including pectus excavatum or sunken chest.

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What is Sunken Chest?

Like a lot of conditions, pectus excavatum can range from mild to severe. It’s a condition present from birth but it usually doesn’t cause problems until bone growth spurts during adolescence, at which the chest usually sinks more.

The chest area, holding the heart, lungs and other body tissue, is surrounded by the ribcage – attaching to the spine in the back and the sternum (breastbone) in the front. The breastbone is usually positioned so there is a slight dip in the middle of the chest. But if that dip is abnormally deep, it can affect how well the heart and lungs function.

Treatment

Surgery

Nuss Procedure is the most common performed surgical treatment for pectus excavatum. This is a minimally invasive surgical procedure through small incisions made on each side of the chest to allow the surgeon to insert a metal support bar underneath the sternum to reverse the depression in the chest. Minimally invasive surgical techniques result in reduced blood loss and shorter operating times that lead to a smoother, faster recovery. The bar is typically left in place for 2-3 years.

Until recently, the Nuss procedure was rarely performed on adults. And, if it was, patients needed to travel out of state to three hospitals that perform the Nuss procedure in adults. Director of Pediatric at Fetal Surgery at Overland Park Regional Medical Center, Corey Iqbal, MD performed the first Nuss Procedure on an adult at our hospital in 2017.

Dustin Lurvey’s sternum was so sunken that it pressed against his heart and lungs. He struggled to breathe whenever he exercised and he could see his heartbeat through his skin. As a child, he was treated for asthma because doctors didn’t connect his symptoms to his sunken chest.

After the Nuss procedure, at 38, Dustin’s chest is flat for the first time in his life. Just six months after his surgery, Dustin can take deep breathes and keep up with his young children.

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Non-Surgical Options

Overland Park Regional Medical Center is the only hospital in the region to offer an alternative to surgery for patients with pectus excavatum. Mild to moderate pectus excavatum may be improved with the vacuum bell, a non-surgical treatment option for patients with pectus excavatum. The vacuum bell is fitted to each patient to sit comfortably on the chest. A bulb attached to the device generates negative pressure to create a vacuum, which raises the sternum over time. The vacuum slowly pulls up the depressed area of cartilage. It may take several months of use to reach the maximum correction. It may require up to two years of regular use to ensure a durable correction. The device allows patients to use it without interfering with school, sports and other daily activities. It is worn several hours each day over 6-12 months.

Read Mat's Story

What is Pectus Carinatum?

Pectus carinatum or pigeon chest is a type of chest wall condition where the chest sticks out. It is not a life-threatening condition, but it can be bothersome to children and cause pain in their ribs.

The exact cause of pectus carinatum is not understood. In cases of pectus carinatum, the cartilaginous portions of the ribs grow outward and cause the chest bone to protrude. Consequently, pectus carinatum usually gets worse when the child is growing through their major growth spurt. In many cases, it may not have even been noticeable until the child had a significant growth spurt. Pectus carinatum is not a life-threatening condition. However, stress on the ribs can cause children to have pain.

Pectus carinatum can easily be diagnosed by looking at the chest. If the protrusion is asymmetric, pectus carinatum can often be confused for pectus excavatum or sunken chest.

Treatment

Bracing is the most common treatment for pectus carinatum. A certified orthotist will customize a brace that is comfortable to wear and will slowly push the chest inward. When bracing doesn’t correct the pectus carinatum or the chest is too rigid to be fixable with a brace, surgery can be performed. Surgery involves removing portions of all the ribs so that the chest bone sinks back into a more normal position. Most children spend five days in the hospital recovering from this surgery and have activity restrictions for several months after surgery to prevent injury to the chest.

Q & A

For optimal results, the Nuss repair is typically offered during early adolescence, but can be performed with excellent results even in adults. Each patient is evaluated on an individual basis to determine a treatment plan that best suits his/her needs.

We generally do not operate on children under six years of age with pectus excavatum. However, we will evaluate children with all chest wall problems at any age and develop a plan for them on an individual basis.

No, your child is not too old to have pectus corrective surgery. We performed our first pectus corrective surgery on an adult in 2017.

No. If you child's symptoms are worsening, then you should begin the steps to have them evaluated and plan for surgery immediately, but correcting the chest is NEVER an emergency. This is a procedure that must be planned. Take your time. Prepare your family and your child for the procedure.

We encourage our patients to maintain active and healthy lifestyles before and after the surgery. Three months post-surgery, patients can return to competitive sports, however contact sports such as football, boxing, and wrestling, are discouraged.

Yes, we treat all disorders of the chest wall and offer operative and non-operative treatments for pectus carinatum (pigeon chest), Poland syndrome mixed-type defects, slipping rib syndrome and more.

After having a brace made, your orthotist will make recommendations on how often to wear the brace. They will be available for follow-up visits to make any adjustments to the brace which can be necessary as the contour of a child’s chest changes with treatment and in case they grow.

The most common complication after treating pectus carinatum is having the carinatum come back. This can happened with bracing or with the surgery. If the carinatum recurs, going back to the brace will oftentimes correct it. Bracing can even be tried after surgery, but it is less common to have a recurrence after surgery.

Use of the brace can lead to skin irritation and in rare cases a pressure ulcer. For these reasons, it is recommended that if there’s any signs of skin irritation or discomfort, follow up with your orthotist to make appropriate adjustments.

There are no long-term effects from wearing a brace to treat pectus carinatum. Surgery for pectus carinatum creates scar tissue around the ribs and this can affect how the ribs grow. Therefore, if surgery is being considered it is usually delayed until the child is through their growth phase.