Pectus excavatum, sometimes referred to as sunken chest or funnel chest, is a deformity of the chest. This medical condition occurs when the tissue connecting the sternum and rib cage overgrows. As a result, areas of the chest appear depressed or sunken. Symptoms of pectus excavatum may be present at birth or develop later in life. Severe cases of pectus excavatum, which make physical activity and breathing difficult, generally require surgery. Plastic surgery for pectus excavatum is also performed for cosmetic reasons.
The Ravitch procedure, also known as open surgery, is the most commonly performed plastic surgery for pectus excavatum. During the Ravitch procedure, a surgeon makes an incision across the patient’s chest. He removes the deformed cartilage while carefully leaving the rib lining in place. Cartilage will regrow in the correct amount and shape. The surgeon then makes an incision in the sternum to properly adjust the bone. A metal support piece may be used to keep the sternum from moving. He then inserts a drainage tube into the chest to keep fluids from building up in the area. Metal support bars are removed after six months.
The Nuss procedure, commonly referred to as closed surgery, is another plastic surgery for pectus exavatum. Closed surgery is less invasive than open surgery. Unlike in the Ravitch procedure, no cartilage is removed from the chest. It is typically used when funnel chest is corrected while the patient is still a child. The surgeon makes a small incision under each arm. A curved metal support is then slid into place under the sternum, with the aid of a camera. The camera is removed from the chest, and the curved metal bar is rotated into its correct position. The metal bar is usually removed after two years.
A patient recovering from surgery for pectus excavatum will have several appointments to monitor healing. Follow up surgeries are needed to remove all metal support bars from the chest. The patient is usually allowed to go home the same day as the surgery is performed.
The patient will be able to return to work or school after two to three weeks of healing. Bathing and showering are usually okay after plastic surgery, because most bandages are removed prior to leaving the hospital. To prevent injury and keep the bar in place, patients should never slouch or sleep on either side. If picking up an item is necessary, the patient should always bend at the hips. Strenuous activity should be avoided for six weeks to three months; however, after some time has passed, exercise will help the chest heal and develop properly.
The Nuss procedure and the Ravitch procedure are generally safe. In some rare cases, bleeding, infection or scarring may occur. Fluid in the lungs or air leakage has been reported. Although severe discomfort or damage to the heart can occur, it is rare.
PubMed.gov: Pectus excavatum in adults
Robert Wood Johnson University Hospital: Pectus Excavatum Treatment
MedlinePlus: Pectus excavatum repair
UK Pectus Excavatum and Pectus Carinatum Information Site: Surgical Treatment
MedlinePlus: Pectus excavatum
MedlinePlus: Pectus excavatum - discharge