07 September 2018
Often noticed at birth, pectus is a condition where the chest is either sunken or sticks out. It affects one to three people per 1,000. The condition can be the source of much distress, but specialists are on hand to help.
Pectus conditions can worsen during growth spurts in childhood and teen years. They can not only cause physical difficulties, but also psychological ones. Once growth is complete, the condition does not worsen and the shape of the chest stays the same.
Here Mr Naidu answers some questions about pectus surgery.
Q: What is a pectus condition?
A: Pectus is the name given to a group of chest problems where several ribs and the breastbone (sternum) grow differently.
There are two main types of pectus:
- pectus excavatum (also known as funnel or sunken chest), where the breastbone sinks inwards
- pectus carinatum (also known as pigeon chest), where a raised breast bone is pushed outwards
Q: Can I develop a pectus condition later in life?
A: Pectus conditions are thought to be caused by growth at the front of the chest, before a child is born. Cartilage connecting the bony part of the rib to the breastbone ‘overgrows’ and causes the breastbone to buckle inwards or outwards. This may become a lot more prominent after the teenage growth spurts
Q: What are the symptoms?
A: There may be physical problems such as chest pain or difficulty breathing during hard exercise. People may also suffer psychological effects such as low self-confidence, anxiety, depression or feeling self-conscious about their body image - with common concerns including being seen without a shirt on (eg swimming).
Other people with a pectus condition do not suffer any major problems, and live happily with the shape of their chest.
Q: Is surgery available?
A: Yes, specialist surgery, known as Nuss and Ravitch procedures are available at Spire Parkway Hospital in Solihull.
Q: How long does the surgery take?
A: Surgery takes between two to five hours, depending on the type and complexity of the surgery.
Q: How does the surgery work?
A: The Ravitch procedure involves a cut on the front of the chest. The cartilages which are causing the deformity are trimmed and refashioned, and then the breastbone is moved (brought forward or pushed back). In some cases a metal bar or plate is required to hold the repair in place. The patient’s own muscles can also be used to provide the necessary support. The Ravitch procedure is particularly useful in correcting patients where the chest sinks or when the chest sinks in more on one side than the other.
The Nuss procedure relies on the flexibility of the chest, hence is better in younger patients. Two small cuts are made on either side of the chest and a small camera is used to guide a curved ‘U’ shaped bar into place, behind the breastbone. It is then flipped, so pushing the chest forward. It stays in place supporting the new shape for two to three years as the body remodels, before being removed in a second smaller operation. Some cases require two metal bars. No cartilage is removed or cut. This operation is often used mainly in patients with a sunken chest.
Q: What are the benefits?
A: Both operations aim to improve the appearance of the chest and may improve low self-confidence and negative body image.
Research shows that repair of sunken or funnel chest can improve the function of the heart and exercise capacity. We do know that both pectus operations have a high rate of long term satisfaction.
Q: Are there any risks?
A: Any surgery has risks - all are discussed in your consultation. Complications are rare but can be serious. Following surgery you may not be happy with the results. On rare occasions the chest may start to go back to its original shape, this can take many years to happen.
Q: Are there any side effects?
A: Scars may become red and thickened in some people, everyone heals at a different rate. After the Nuss procedure you may initially feel the bar pushing your chest, this sensation usually settles over several months.
In order to control any pain, a multi-pronged personalised approach is followed.
Q: What happens after the procedure?
A: Patients, on average, stay in hospital for three to five days. Patients are discharged once they are well enough and meet our criteria:
- Able to walk on your own and up stairs
- Pain well controlled
- Bowels working
- Support from friends and family at home
Painkillers are continued at home, reducing as pain improves - the consultant and nurse give advice on how to do this. Patients gradually return to normal activities, however, (with) some tasks, we advise a set time limit before attempting.
A follow up appointment to see a consultant is made for a post-op check-up, (this is done) between four to six weeks after discharge is made. And depending on the nature of (your) work, patients need from six weeks to six months off.
Q: How quickly could I have a consultation, and how much would it cost?
A: It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours. Initial consultation fees vary by consultant, but around £175 is a reasonable guide.
Q: If I need surgery, how quickly could I have it?
A: We have no waiting lists at Spire Parkway, but again, it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks.
Q: I don’t have health insurance, can I self-pay?
A: Yes, you can. Our self-pay team can talk you through this and explain the finance options that are available, should you wish to explore them. Call 0121 704 5530, or click here to submit an enquiry online.