Pectus Excavatum

Treatment

Pectus excavatum treatment varies depending on the severity of the condition. Mild cases may be monitored closely for a time by your doctor to determine the most appropriate treatment option. An exercise and posture physical therapy program also may be recommended for mild cases. Surgical correction is often recommended for moderate to severe cases of pectus excavatum that impact the patient's heart and lung function.

Surgery

Pectus excavatum repair surgery can be performed at any age but may be necessary at a young age for severe deformities. Patients with a severe deformity can have physical limitations such as reduced exercise tolerance and chest discomfort, and experience breathing problems. Surgery to correct pectus excavatum can be safely performed with few complications and a short hospital stay. Mayo's treatment team members work closely together to ensure that the patient returns home with appropriate instructions for incision care, pain management, exercise and other daily activities.

Before surgery (Nuss procedure)

X-ray of steel bar inserted under the chest wall.

After Nuss surgery

Highly skilled pediatric and thoracic (chest) surgeons at Mayo Clinic perform a minimally invasive surgery (the Nuss procedure) or open chest surgery to repair pectus excavatum deformities. These technically challenging procedures have changed considerably over the years as new, innovative, surgical variations have been developed to better correct the structure and look of the deformed pectus (chest wall).

The ideal time to perform surgery is during the adolescent growth spurt (ages 11 to 14), before bone and cartilage (the fibrous connective tissue between the ribs) mature. The adult chest wall is stiffer and harder to reconfigure. But the surgery also can be performed successfully in adults.

Minimally invasive surgery (The Nuss procedure)

During the minimally invasive operation, a customized stainless steel bar, fashioned to fit each patient's chest shape, is placed under the pectus (chest wall) and rotated into position, completely correcting the defect. Only two small incisions are required, one on each side, hidden beneath the arm.

Minimally invasive pectus excavatum repair surgery offers excellent results in more than 90 percent of patients, including those patients who have undergone a previous open chest surgery procedure that failed to correct the deformity. The Nuss procedure is proven safe, requires a shorter operating time than former repair techniques and avoids removing cartilage. It is more commonly performed on pediatric patients than adult patients.

Open chest surgery

For older patients who have severe pectus excavatum defects, an open chest procedure may be necessary. During this operation, an incision is made in the center of the patient's chest and short segments of abnormal cartilage next to the sternum (breastbone) are removed. The ribs are re-formed so the chest is more normally shaped, and put back together with small stainless steel wires.

Finally, a thin, stainless steel bar is placed across the repaired chest to secure and stabilize the bones and muscles while they heal. After about six months of healing, the stabilizing bar is removed during a simple, outpatient surgery.

Most patients can expect improvement in their symptoms and few restrictions on physical activity after pectus excavatum repair surgery.