Having a chest wall defect such as pectus excavatum (sunken chest) or pectus carinatum (pigeon chest) can be difficult for your child to navigate on top of their already changing body. That’s why we’re here with our Medical Director and expert pediatric surgeon, Christopher Anderson, MD to help you learn more about what these abnormalities are, when and why they occur and what treatment options are available so that your child can feel whole in mind, body and spirit.
What is Pectus?
Pectus, or a chest wall defect, is an abnormality in the structure of the chest caused by uneven growth of the cartilage that connects the ribs. Dr. Anderson explains, “While the exact cause or etiology of pectus defects is unclear, it’s quite common. Pectus excavatum, or sunken chest, affects about one in 400 children. Pectus carinatum, or pigeon chest, affects about one in 500 children. Both types are more commonly found in males than females and it can run in families.”
Pectus Excavatum Vs. Pectus Carinatum
Pectus excavatum, also known as sunken chest, occurs when the sternum (or breastbone) is pushed into the chest due to atypical growth of costal cartilage, giving the chest a concave look.
Pectus carinatum, also known as pigeon chest, is the opposite where the sternum protrudes outward. The protrusion can occur on both sides of the chest, or it can be uneven with one side sticking out more than the other.
Dr. Anderson says, “Both types of chest wall defects can appear in a child as early as one year old, but they typically begin to show anytime from early childhood to adolescence. While the defect may start out mild with your child experiencing little to no symptoms, it can develop into a more serious issue during puberty when your child’s bones and cartilage are rapidly growing.”
Why Should I Seek Treatment for My Child With Pectus?
A common reason those with pectus seek treatment is the cosmetic appearance of the chest. The abnormality can have psychological effects on self-esteem, perception from peers and body image, especially on a child navigating their already-changing body. Dr. Anderson states, “I often get male patients who are reluctant or too self-conscious to take off their shirts at the beach or pool due to social pressure from peers about the appearance of their chest. Post-operative patients often have improved self-esteem, and some are even encouraged to start lifting weights to improve their physique in a way they haven’t been able to before.”
Another important reason to seek treatment for pectus excavatum (sunken chest) specifically, is to ensure it isn’t causing medical complications with the heart and lungs due to the compression the chest defect can place on them.
Pressure on the heart can cause heart arrhythmias, heart murmurs and abnormalities with the heart valves.
Compression of the lungs can result in limited lung capacity and inhibit exercise tolerance, which can be especially limiting for student athletes.
Treatment Options
Depending on the severity of the abnormality, and if it’s diagnosed early while the chest is still maturing, corrections can be made with a vacuum bell or brace. “If surgery is required, it’s typically minimally invasive with shorter recovery times and a better cosmetic look than in years past thanks to advances in technology and the overall surgical process,” encourages Dr. Anderson.
Non-surgical Treatment Options
Pectus Brace (for pectus carinatum or pigeon chest):
- It’s worn during day-to-day life under (or over, if desired) clothing for as long as the patient can stand to wear it or as prescribed by their doctor
- Some wear it only during the day while others wear it at night while sleeping
- The longer it’s worn, the faster the correction
Vacuum Bell (for pectus excavatum or sunken chest)
- A circular rubber vacuum seal is pressed against chest while a ball is squeezed to create the vacuum effect that pulls the chest upward
- Done at home by the patient as often they can or as prescribed by their doctor
Surgical Procedures (for pectus excavatum or sunken chest)
Ravitch procedure vs. Nuss procedure:
The Ravitch procedure is an open approach where the rib cartilage is removed or reshaped, and the sternum is placed in the correct position.
The Nuss procedure has become the preferred method as it is minimally invasive with small incisions made to allow a bar to be placed behind the sternum to lift it up to the correct position.
Procedural advances:
- Nerve freezing staves off surgery pain by temporarily freezing the nerves in the chest wall
- Using a scope to dissect behind the breastbone and elevating the breastbone with a retractor make the procedure much safer, avoiding affecting the heart
- The bar used in the Nuss procedure is titanium, which has a less likelihood of causing allergic reactions and has eliminated the need for preoperative allergy testing
- Cosmetic improvements are seen with the Nuss procedure compared to the Ravitch procedure regarding incision location, size and scarring
Recovery:
Recovery from surgery is no longer painful like it used to be due to a new technique of temporarily freezing the nerves in the chest wall during surgery, which leaves the chest numb for about 6 to 8 weeks after surgery. This results in shortened hospital stays, down from 7 days to 24 to 36 hours, and greatly improves at-home recovery discomfort.
According to Dr. Anderson, “Children can go back to school within a week, but do need to stay away from contact sports after the Nuss procedure for about two years, as opposed to three years previously.”
Find Specialized Children’s Chest Care Here
Our chest wall care team at AdventHealth for Children offers the latest nonsurgical and surgical treatment options for pectus excavatum, pectus carinatum and other complex chest wall disorders.
Visit us here to learn more about how we can support your child on their path to wholeness.
