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Chest wall deformities

Pediatric SurgeryA chest wall deformity is an abnormal development in the chest wall. The condition is fairly common and the abnormality can vary from mild to severe.

These deformities are more common in boys and in Caucasians. Up to 40 percent of patients will have an affected family member and several monogenic syndromes are associated with pectus deformities including Marfan Syndrome, Homocystinuria and Ehlers-Danlos Syndrome. It can either be present at birth or not develop until puberty. The two most common congenital chest wall deformities fall into the categories of pectus carinatum (sometimes called pigeon chest or sternal protrusion) and pectus excavatum (also called funnel chest or sunken sternum). Treatment will depend on the level of severity.

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Pectus excavatum also known as funnel chest

For children with pectus excavatum, chest wall deformities may range from mild to severe. Mild cases might be barely noticeable. Pectus excavatum can be completely harmless, but the visual appearance can affect a child's self-image, and they may also be subjected to teasing and even bullying. Severe cases can cause a deep hollow in the chest and may affect the heart and lungs. Surgery can often correct the condition and treat any heart or lung issues.

Who gets it?

Pectus excavatum affects about 1 in 400 children, and is most common in males although females can be affected as well. Up to 40 percent of patients will have a family member, typically a parent or grandparent, who also has it, but there is no clear genetic link … there are several monogenic syndromes associated with pectus deformities including Marfan Syndrome, Homocystinuria and Ehlers-Danlos Syndrome. It can either be present at birth or not develop until puberty.

before photoafter photo

Male, before and after

female before and after photo

Female, before and after

What causes it?

It is generally regarded as a genetic condition, based on the fact that it is usually present in several members of the same family and is often associated with other genetic diseases; however, its causes remain in debate.

What are the symptoms?

Common symptoms of chest wall deformities are:

In addition, your child may also have chest pain related to abnormal bone and cartilage growth. Pectus excavatum typically gets worse with age or during growth spurts that occur during adolescence.

How is it diagnosed?

Workup of pectus excavatum includes your child's medical history and a physical exam, along with one or more of the following tests:

How is it treated?

Treatment of mild pectus excavatum may consist of exercises for improving posture and upper body strength. If your child has moderate to severe pectus excavatum, surgery may be recommended.

Nonsurgical options

For mild deformities, posture control, exercise program (e.g., deep breathing, pushups) and annual follow-up may be appropriate. Many patients are candidates for this non-operative treatment before considering surgical repair. Other non-operative options such as suction devices can be used. Compliance is important for optimal results.

Surgical options

Pediatric Surgery barThe timing of surgery is dependent on your child's age, symptoms and anatomy. Surgical options are generally deferred until mid to late adolescence—if symptoms allow—to prevent problems with chest wall compliance which may occur if done in younger patients.

Nuss minimally invasive repair of pectus excavatum (MIRPE)

Ravitch repair*

Pectus carinatum (sternal protrusion), pigeon chest

Who gets it?

carinatumPectus carinatum is less common than pectus excavatum. Only a fifth as many children have it. It is more common in in boys – only 1 in every 4 patients diagnosed with this condition are girls. It generally appears later than excavatum deformity (50 percent by 11 years of age). This condition also worsens during puberty.

What causes it?

It is generally regarded as a genetic condition, based on the fact that it is usually present in several members of the same family and is often associated with other genetic diseases; however, its causes remain in debate.

What are the symptoms?

Common symptoms are:

How is it diagnosed?

Workup includes your child’s medical history and physical exam. Less common, one or more of the following tests are performed:

How is it treated?

pectus carinatum braceSurgical repair is an option for people with severe pectus carinatum, but a compression brace can be used to help flatten the chest in most patients. The pectus compression brace is a custom brace made by Cook Children's Orthotics and Prosthetics. This is a preferred treatment for children whose bones are still growing. The brace is worn 16-23 hours a day for the first year and 12-16 hours for the second year. Many patients are candidates for this non-operative treatment before considering surgical repair. Results are often seen in just a few months, when worn according to instruction. Correction is faster and more complete for younger children.

Ravitch repair

What to expect after surgery

Post-operative pectus information

After surgical repair of your pectus deformity, you will have a steel bar that is positioned across the chest under the breast bone. The bar usually stays in for 2-3 years.

Please follow these instructions to minimize changes or problems with the bar:

Additional information

When to call the doctor

Success stories

Pediatric Surgery

"Keeping up with other athletes was nearly impossible. As I ran, my lungs felt like they were collapsing. A dear friend referred me to Dr. Iglesias, and I was diagnosed with pectus excavatum. After surgery, only a few short months later, I was back in action. I soon began to realize that I could breathe more easily, and I could take deep breaths just like my teammates. What a success this procedure was for me! I thank God that I was able to receive care from some of the greatest nurses and doctors at Cook's Children's."

—Miami R. (patient)

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Patients can make an appointment and physicians may refer a patient by calling 682-885-7080. New patients, for your convenience, please have your insurance information ready.

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