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Chest deformities are a relatively rare problem for young teens but can greatly affect their self-esteem and might lead to difficulties in the functioning of their heart and lungs. Fortunately, minimally invasive techniques are available at Royal Brompton & Harefield Hospitals Specialist Care that can safely return chests to a normal shape.

Knocking body confidence

The two most common chest deformities are pectus excavatum (‘funnel chest’) and pectus carinatum (‘pigeon chest’). They occur when the breastbone sinks in (pectus excavatum) or protrudes out (pectus carinatum) of the chest. It is not known exactly how these conditions occur, but it is thought to be due to the cartilage in the ribcage overgrowing.

These conditions may not be obvious in childhood and present themselves mostly during the growth spurts of adolescence. They occur more often in boys than girls and are relatively rare disorders affecting about 1 in every 1,000 children for pectus excavatum and 1 in 1,500 for pectus carinatum. As these conditions appear to run in families, there may be a genetic link.

As the ribcage is more rigid than normal for both conditions, they can result in difficulty breathing, chest pain and an irregular heartbeat – particularly on physical exertion. However, the main impact is psychological. Due to the chest’s appearance, the conditions can cause significant embarrassment for children, resulting in low self-esteem and clinical depression. They often exclude themselves from social and sporting activities, particularly those that require them to expose their chests, such as swimming.

Normal Pectus excavatum Pectus carinatum

Correcting deformities with minimally invasive techniques

Past procedures to correct chest deformities were very invasive and involved surgically removing the deformed cartilage around the breast bone and fixing it into a normal position using metal and mesh supports. Fortunately, less invasive techniques are now available.

Pectus carinatum can be treated with a chest brace which applies pressure to the front and back of the ribs to gradually move the breastbone back to where it should be. The patient wears the brace for anything between a couple of months up to a few years depending on a few variables and the severity of the deformity. Ideally, the brace should be worn as many hours a day as possible, but it could be removed for showering or sporting activities.

Pectus excavatum can be treated with the minimally invasive Nuss surgical procedure. Small incisions are made either side of the chest and one to three curved metal bars are placed behind the breastbone to push it into a normal position. The bars are kept in place for one to three years before removing – after which time the ribs stay in their new shape.

“The Nuss procedure is very quick, taking around 45 minutes, and the patient can leave hospital within two to three days. Due to the positioning of the bars, the patient will need to reduce their physical activities until they are removed and there is pain experienced to start. However, we have an excellent pain management team to support them and the visual results are pretty instant.”

 - Mr Nizar Asadi, consultant thoracic surgeon at RB&HH Specialist Care.

 

 

The Nuss procedure for pectus excavatum. Metal bars are inserted through incisions on either side of the chest and flipped up to lift the breastbone to a normal position

Helping a young man be more active

At the age of 22, Andrew had been living with pectus excavatum for years. He led a very active lifestyle growing up, earning a black belt in martial arts, as well as regularly cycling and rowing. However, he always felt his chest was limiting his sporting abilities.

He explains:

“It wasn’t so much the cosmetic side that bothered me, but I feared that if someone hit me particularly hard in the chest with my ribs that close to my heart, it might do some serious damage. Also, with the shape of my chest, my lungs didn’t have anywhere to go – it felt quite uncomfortable every time I exerted myself. So, I felt I had to do something about it.”

Mr Asadi says:

“We performed the surgery on Andrew over a year ago and were very pleased with his results. However, as he hasn’t been able to take part in the sporting activities he loves, he is understandably very keen to have the bars removed – which we intend to do very soon.

“Andrew received the surgery through the NHS, but unfortunately it is no longer funded due to being considered cosmetic in nature. However, we know these conditions can cause considerable distress to those affected and encourage GPs to refer patients who would like to explore these treatments privately to help improve their body confidence.”


Mr Nizar Asadi

Consultant thoracic surgeon

 Mr Asadi specialises in minimally invasive  thoracic surgery.