Pectus Excavatum

The cause is unknown. The cartilage that attaches the ribs to the sternum grow abnormally and pushes the sternum in. This causes the sunken look. Pectus excavatum can run in families. It may be seen during infancy or noticed later in life. The depression becomes more noticeable as your child grows.

A common misconception is that pectus abnormalities are merely a cosmetic issue. Children with moderate to severe defects can have shortness of breath, chest pain and trouble breathing when exercising. A common complaint is “I can’t keep up like I used to.” Surgery to correct pectus excavatum is usually done when the child is a teenager.

If the defect is moderate to severe and your child has some or all the symptoms, your surgeon will order tests to assess heart and lung function. These may include a CT scan of the chest, an exercise test that monitors lung function and possibly an echocardiogram (ultrasound of the heart).

The two kinds of operations done at Beaumont Children’s to correct pectus excavatum are the Ravitch procedure and the Nuss procedure.

• In the Ravitch procedure, the abnormal cartilage is removed. The sternum is repositioned and at times stabilized with a steel bar. This bar is removed about six months later during a same-day surgery.
  

• The Nuss procedure involves small incisions. A steel bar is bent into the desired chest shape and is passed under the sternum. The bar is used to “pop out” the depression. This bar is removed in about three years during a same-day surgery.

The most common complication of surgery is a pneumothorax. This is when air leaks inside the chest and causes a partial collapse of the lung. This usually gets better on its own. There is also a small risk (less than 10%) of the bar moving out of position. The risk of infection is less than 1%.

Ninety-five percent of repairs result in improved appearance. In 5% of cases the chest becomes sunken again after the bar is removed. For most children, symptoms of pain and shortness of breath lessen and exercise becomes easier after the surgery recovery period.

It is normal to have pain and discomfort after either procedure. After two weeks, your child’s discomfort may be controlled with anti-inflammatory drugs and an opiate for breakthrough pain.

The nurse will discuss all other medicines that can be used to control pain with you before you leave the hospital.

Your child’s activity will be limited for the first four to six weeks after surgery. Avoid heavy lifting for the first two months (this includes heavy backpacks). Start walking as soon as possible to build strength.

Other limits on activity will be made by your child’s surgeon. During the first month, it is important not to slump or slouch while sitting, and to bend at the hip when picking up items from the floor. Good posture will help keep the bar in place and help your child have the best results.

It is okay for your child to shower once they have returned home. Sutures that dissolve on their own are used to close the incisions, so there will be no stitches that need to be removed.

They may be uncomfortable when flat on their back. Have your child try to sleep in a recliner or prop pillows under their mattress so they are lying in a raised position.

Yes. Because your child may have a metal bar inside their chest for several months to years, we suggest your child wear a Medic Alert bracelet or Medic Alert jewelry during that time.

The first follow-up visit should occur about two weeks after your child is released from the hospital. More visits will be needed to check progress and start a controlled exercise program.

• temperature is greater than 101.5 F
  
• redness, swelling, drainage or bleeding from the incisions occur
  
• pain not controlled with pain medications
  
• problems with breathing
  
• injury to the chest that may have caused the bar to move
  
• any questions or concerns