Pectus Excavatum is a condition where when the center of the chest curves inwards.
Sometimes, it may be asymmetrical, and the lower ribs may flare out.
It can be present at birth, but typically gets deeper during adolescence.
We’re not sure what causes Pectus Excavatum, but it is more common in boys than in girls,
can sometimes run in the family, and is due to extra cartilage growth around the sternum.
Mild cases may not show any symptoms, but moderate cases can result in shortness of
breath, fatigue, and decreased physical endurance.
In severe cases, the sternum may compress the heart and lungs, causing chest pain, or
decreased lung capacity.
People with severe cases can still have relatively normal levels of physical activity.
Many also experience low self-esteem, social anxiety, and stigma due to the appearance
of the chest.
Although Pectus Excavatum is not life-threatening, surgery can restore volume to the chest, increase
lung and heart capacity, and improve the appearance of the chest.
The primary surgical option is the Nuss Procedure.
The Nuss Procedure is a two-part, minimally invasive surgery that uses a temporary metal
bar to push the sternum out.
The bar acts like a brace for the sternum, allowing it to reform into a more correct
position, without breaking or cutting any ribs.
Results are best in 12 to 16 year olds, but can work in older patients as well.
At Children's Hospital Colorado, we will examine your chest, which typically includes a CT
scan of the chest, an echocardiogram, or other pulmonary function tests.
The first surgery, the bar insertion, takes about two hours.
You will be given general anesthesia, as well as a thoracic epidural, which will block most
of your pain during recovery.
First, your surgeon will create three small incisions: two one-inch incisions for the
bar, and a quarter-inch one for the camera.
Next, the bar is inserted between the ribs, brought in front of the heart and lungs, through
a thin area of connective tissue under the sternum, and through to the other side.
After the bar is positioned, it is rotated into place.
This pushes the sternum out, and corrects the curvature.
Some patients may need two bars in severe cases.
Finally, a metal stabilizer is placed on one side, and absorbable sutures on both.
Over several weeks, your body coats the bar with a thick sheath of fiber, securing it
in place.
The bar will stay in place for two to four years, depending on your age, and how much
growing you have left to do.
During this time, the cartilage that was bent into-place by the bar re-forms into its new
position.
This stabilizes the sternum, so once the bar is removed, the sternum stays in place.
The bar, however, does not correct the flared ribs.
Most patients stay in the hospital for three to five days after surgery.
Recovery from the Nuss procedure is often quite painful, but we will help you transition
off the epidural and manage your pain using oral medication, and may begin physical therapy
as well.
Once home, most patients get off their pain medication in one to two weeks, and then return
to school.
After three to four weeks, most patients return to low-impact activities, such as running
and swimming.
After three months, patients can return to full activity, like weight lifting, and even
contact sports.
For the second surgery, the bar removal, we will see you every three to six months until
your bar is ready to be removed.
Bar removal is a much simpler, outpatient procedure, and usually only takes an hour.
First, the stabilizer is removed.
Next, the bar is carefully taken out.
The chances of the sternum reverting back to its original position are very low, less
than five percent.
Most patients will only need pain medication for two to three days after bar removal, and
return to full activity after two weeks, with no long-term restrictions.
We’re ready to help you get better.
To learn more, call us, or visit our website below.