Up to 4% of all infants are born with a structural or genetic difference — often called a congenital abnormality — that can alter how the body looks or functions.
Pectus excavatum is the most common variation in the structure of the skeletal chest wall, but it sometimes isn’t obvious until adulthood. In this article, you will learn more about pectus excavatum, and how it can be corrected with surgery.
Pectus excavatum is a deformity of the chest wall that is usually present — if not noticeable — at birth. With this congenital abnormality, the sternum (or breastbone) and some ribs turn inward. These structural changes can give the chest a caved-in appearance and are present at birth, but it’s most often diagnosed in the teenage years.
The condition is more common in boys than in girls and appears in between 1 in 300 to 1 in 1,000 infants. By adulthood, that prevalence drops to about 1 in 25. Most people with this condition have a mild form that only impacts physical appearance, but in people with more severe types, they can have breathing or heart problems caused by pectus excavatum.
Pectus excavatum surgery is a general term used to describe a variety of surgeries that can correct this deformity. The ideal technique to correct pectus excavatum is very specific to the individual.
- Open surgery (the Ravitch procedure): This method, used for almost a century, is the oldest and most invasive surgical technique for correcting pectus excavatum. Depending on your specific structural abnormalities, areas of cartilage, bone, or muscle may be removed or repositioned. While there are newer, less-invasive techniques, open surgery methods are still used safely around the world.
- The Nuss technique: This method was introduced in 1998 by Donald Nuss and has gained popularity as a less-invasive alternative to open surgery. This surgery doesn’t require cutting, resection, or cartilage or bones in the sternum as in open surgery. Instead, a metal rod is implanted to move the sternum into a better position. There are variations in this technique, including the Wang procedure, which involves different methods for implanting the rod and repositioning the sternum. The rods are usually removed after a few years.
The technique that is best for you is a choice that needs to be made between you and your surgeon. The Nuss procedure can reduce your time in surgery and the amount of blood lost, but studies have found little difference in the overall outcomes between open and minimally invasive techniques, especially for children. In adults, the Nuss procedure has been associated with a lower rate of postoperative complications.
Regardless of what technique is used to surgically correct pectus excavatum, it is a major surgery that will require more than an hour of surgery and general anesthesia. For some people, an external device called a vacuum bell may help, but if surgery is required, a number of tests will be needed prior to surgery.
The decision on whether you are a good candidate for surgery is usually based on the severity of the pextas excavatum and what other problems — like breathing difficulties — it is causing.
Imaging studies will help your surgeon pinpoint the exact structures that need to be taken out or moved during surgery, and will help them visualize other organs or structures that are being compromised by the deformity.
Before surgery, will have received specific instructions on when to stop eating, and what medications you should or should not take in the days prior. You may have additional testing done on the day of surgery.
When your surgeon is ready to begin the operation, you will be taken to the surgical area and placed under general anesthesia. This is a medication that allows you to sleep and slows your body systems during the operation. During general anesthesia, you can expect to have a breathing tube placed to help you breathe. You will not be awake and will not feel pain during surgery.
To begin surgery, you will be placed on an operating table and the area will be scrubbed and cleaned with antiseptics. Your upper torso will be covered with sterile drapes to prevent infection and surgical incisions will be made based on the specific technique your surgeon has chosen.
After surgery, any incisions made to access your chest wall will be closed with staples, stitches, or another surgical closure device. You will be monitored closely in a postoperative area while you wake up from anesthesia. When you begin to wake up, the breathing tube will be removed, and your healthcare team will continue to monitor you for any complications.
After surgery, you should expect to remain in the hospital for several days to be monitored for complications and for wound care. Your surgeon will give you specific instructions on when staples or stitches can be removed, and how to care for your incision. You may need to stay in the hospital for up to 10 days after pectus excavatum surgery, and complete recovery can take several months.
As with any major surgery, there is a risk of infection and other complications with pectus excavatum surgery. Different techniques carry specific risks.
With open surgery, the most common complications after surgery include:
With minimally invasive methods like the Nuss technique, complications can include:
- heart problems
- a problem where the rod is attached
- reactions to the metal implant
Overall, most studies conclude that people who need surgery to correct pectus excavatum report a higher quality of life after the operation. In one study,
- shortness of breath
- abnormal cardiac rhythms
When to call your doctor
If you develop any of the following difficulties, call your surgeon immediately or seek emergency medical treatment:
- difficulty breathing
- chest pain
- signs of infection
- unexplained fever
- swelling at the incision site
What causes pectus excavatum?
Nearly half of people with pectus excavatum have relatives with other chest anomalies. Even if it hasn’t affected your family, this condition is something you are born with, not something you acquire over time.
Will I need extra surgeries?
With an open repair of pectus exacavatum, repair should be permanent, and followup surgeries should only be needed due to complications or other related issues. With minimally invasive techniques, another procedure will be required at some point — usually after a few years—to remove the metal rod that helps to reposition the chest wall.
Is there an ideal age to have this surgery?
Adults tend to have more complications from pectus excavatum surgery than children, but the decision about when to have surgery is best made by you and your surgeon based on the degree of problems the condition is causing you.
What will pectus excavatum surgery cost? Will my insurance cover it?
The cost of this surgery will depend on the technique used for your surgery, what complications you may develop, and other health factors unique to you. If your surgeon indicates that your surgery is medically necessary, it is likely to be covered by your insurance, but check with your individual plan before scheduling surgery. Different health plans may assign you different shares of the surgical cost.
Pectus excavatum is a serious chest wall deformity that can cause problems with how your heart and lungs work. If the problem is severe enough, it will require surgery that has the potential to greatly improve your quality of life.