Pectus excavatum – what is worth knowing about pectus excavatum?
Pectus excavatum (Latin: pectus excavatum ), also known as pectus excavatum , is a congenital chest defect in which the sternum sinks into the chest cavity. While many people can live with this anomaly without significant discomfort, in some it can affect the respiratory and cardiovascular systems, significantly impacting self-esteem and quality of life. This article aims to explain the nature of this defect and the available treatment options, with a particular emphasis on surgical methods.
What is a shoemaker's chest?
is the most common deformity of the anterior chest wall in children and adolescents , occurring in approximately 1 in 300–400 births, and significantly more often in boys than girls. The characteristic symptom is a sunken sternum, which may be mild, moderate, or profound.
This deformity usually becomes apparent in childhood and its severity often increases during the period of rapid growth, i.e., adolescence.
Symptoms and consequences of pectus excavatum
In many patients, pectus excavatum is merely aesthetic and has no impact on physical health. However, in more advanced cases, it can lead to:
- shortness of breath on exertion,
- getting tired easily,
- chest pain,
- heart rhythm disturbances.
Psychologically, children and adolescents with this condition often struggle with low self-esteem. They avoid physical activity and social situations where the deformity is visible (e.g., swimming pools or locker rooms).
Treatment – is surgery necessary?
Not every case requires surgical intervention. In mild cases, observation, breathing exercises, and strengthening of the chest muscles are recommended. However, in patients with moderate to severe conditions—especially those with physical symptoms or significant psychological discomfort— surgical treatment of the pectoralis major .
When is the best time to perform surgery?
Pectus excavatum surgery is best performed during early or middle adolescence – typically between the ages of 11 and 16. At this age, the sternum and ribs are still flexible, which increases the effectiveness of the surgery and reduces the risk of complications. Performing the procedure before the end of rapid growth also allows for better adaptation of the chest shape to the body's future development.
Procedures for adults are also possible, but may require greater corrective force and involve a longer recovery period. To qualify for surgery, a patient should see a physician specializing in thoracic surgery.
Surgical treatment – two main methods
1. Ravitch method (classical)
This is an older surgical technique that involves surgically removing deformed rib cartilage and realigning the sternum. Although effective, it is a more invasive procedure with a longer recovery time.
2. Nuss method (minimally invasive)
Currently, it is the most commonly used procedure. It involves inserting a curved metal plate (in some cases, two) under the sternum, which pushes the sternum outward. The procedure is performed through small incisions on the sides of the chest. The Nuss procedure is the standard treatment in many countries. The plate is removed after approximately 2–3 years, once the sternum has stabilized in its new position.
Cryoanalgesia – a modern approach to pain relief after surgery
Cryoanalgesia , which involves temporarily freezing the intercostal nerves using a special cryogenic probe, is increasingly used in Nuss surgery The goal of cryoanalgesia after Nuss surgery is to significantly reduce postoperative pain , thereby reducing the use of strong painkillers (opioids) and accelerating recovery. Cryoanalgesia is safe, effective, and increasingly common in modern thoracic surgery.
What is worth knowing before surgery?
- The procedure is performed under general anesthesia.
- The length of stay in hospital is usually about 5 days.
- It takes several months to return to full physical activity.
- The aesthetic and functional results are usually very good.
- Removal of the plaque usually takes place after 2-3 years and is much less burdensome.
Potential complications after surgery
Like any surgical procedure, breast augmentation surgery carries a risk of complications. These include:
- postoperative pain (significantly reduced by cryoanalgesia),
- displacement of the plate,
- surgical wound infections,
- allergic reactions to the plate material (before the procedure, we perform allergy tests for metals to avoid allergic complications),
- adhesions and scars,
- recurrence of deformity (rare, mainly when the plate is removed too early).
The risk of complications is relatively low, especially in experienced centers, and most potential problems can be treated effectively.
Summary
A chest wall is a condition you can live with, but in many cases, treatment is worth considering—not only for health reasons but also for psychological ones. Currently available surgical methods, especially the Nuss procedure using cryoanalgesia , allow for effective and comfortable restoration of the chest's normal shape. Thanks to this procedure, patients can quickly return to normal life with improved posture, respiratory function, and self-confidence. If you have a family member with this condition, or you have it yourself, it's worth consulting with a thoracic surgeon to discuss the best treatment options.
Dr.
Robert Chudzik
Thoracic Surgeon
Also check out: www.pectus.com
The information contained in this article is for general informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. It is recommended that you consult a physician or other qualified healthcare professional for advice regarding specific symptoms, ailments, or health conditions.