What Is Pectus Excavatum?

Pectus excavatum is a condition in which the cartilage connecting the sternum and ribcage does not grow normally, causing a sunken appearance or indentation in the chest. It occurs most commonly in the early teenage years and affects boys five times more often than girls.

The severity of this condition varies, but your child may experience shortness of breath or fatigue during exercise if his or her ribs and sternum press on the heart or lungs. The appearance is sometimes physiologically challenging. Your doctor can measure the size of the indentation and how it affects your child’s breathing and heart performance with tests like a stress test or CT scan. They can then advise you on whether your child may benefit from surgery.

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Pectus Excavatum Surgery

Pectus excavatum can be corrected with one of two different procedures, the Nuss procedure or the Ravitch procedure. You might consider these procedures if your child has symptoms like:

  • Chest pain
  • Shortness of breath
  • Chest CT showing a severe indentation or compression of the heart
  • Changes in breathing or heart tests
  • Embarrassment or stress about appearance

In some cases of pectus excavatum, corrective surgery may not be necessary. If the condition does not bother your child, make physical activity difficult, or have a negative impact on your child’s self-image, you can choose not to pursue treatment. This decision will vary from person to person. Talk to your child’s doctor about the best option to fit your child’s needs.

Procedure

The Ravitch procedure cuts away abnormal rib cartilage and repositions the sternum, leaving a bar in the chest.

The Nuss procedure is less invasive. In this procedure, your child will be measured for a metal bar that will be placed in his or her chest. The surgeon will make two small incisions, one in each armpit, and then position the bar to raise the sternum and correct the depression in the chest wall. The bar typically will be removed after two to three years.

Your child will be given an IV with medicines for pain, constipation, anxiety, and muscle relaxation. We encourage you to give your child over-the-counter laxatives for two days prior to surgery to prevent constipation.

Recovery from Surgery

After the surgery, your child will need to take certain precautions to help in their recovery. In the hours following the procedure, he or she will need to take deep breaths using a breathing machine (incentive spirometer) to prevent lung congestion and pneumonia.

Your child will be able to leave the hospital once their pain is controlled and when he or she is able to move around stably. Your child can go back to school when he or she feels ready. Sometimes this can take as long as three weeks after surgery.

Your child should sleep flat on his or her back for the first two weeks following surgery.

Medications

Your child will receive a prescription to manage their pain for the first week after surgery. You can also give him or her Ibuprofen two to three times a day for several weeks to help with pain or swelling. If your child experiences constipation while on the pain medication, you can give him or her Milk of Magnesia, Colace, MiraLax, or Senna.

Exercise & Physical Activity

You can help your child perform posture exercises and walk for 5–10 minutes a few times every day to build strength, but do not let him or her over-exert for the first 4 weeks. After 6–8 weeks, your child can resume aerobic activities like running and daily exercises. After 12 weeks he or she may resume sports like golf, baseball, and swimming, but should be careful to avoid any possible injuries, especially to the chest.

Contact Your Doctor if Your Child Experiences:

  • A temperature higher than 102 degrees Fahrenheit
  • A persisting cough or any difficulty breathing
  • Chest pain, especially with deep breaths
  • Any chest injury that may cause the bar to move
  • Redness, drainage, or swelling at the incision site