The Chest Wall Deformity program at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, evaluates and treats children and young adults with pectus excavatum. Our highly qualified surgeons are committed to improving the lives of patients with pectus excavatum.

Why Choose Johns Hopkins All Children's

Our surgeons are specially trained to diagnose and treat pectus excavatum and have extensive experience in surgical approaches to repair the condition. We use the latest surgical techniques and work closely with specialists across our hospital to provide patients and families with the highest quality of care. Our team is leading national research efforts on the best ways to diagnose pectus excavatum and to optimize the healing process following pectus excavatum repair.

What is pectus excavatum?

Pectus excavatum is the most common chest wall deformity, occurring in about one in 500 children and accounting for more than 90% of congenital chest wall deformities. Pectus excavatum is where the sternum and ribs develop abnormally, causing the sternum to drop inward toward the spine and produce a caved in or sunken appearance of the chest. This condition progresses throughout childhood and is sometimes referred to as “funnel” chest. Pectus excavatum is usually diagnosed within the first year of life and is three times more common in boys than girls. The typical age that pectus excavatum is repaired is mid-adolescence once rapid growth spurts have occurred.

The exact cause of pectus excavatum is unknown. Recent information suggests causes may be linked to:

• A genetic component
• An imbalanced growth of the sternum and ribs
• Musculoskeletal disorders such as scoliosis and Marfan syndrome, which suggests abnormal connective tissue (note: the majority of patients with pectus excavatum do not have musculoskeletal disorders) 

What are the symptoms of pectus excavatum?

Often, patients don’t have any symptoms. Some patients, however, may experience:

• Chest pains
• Shortness of breath
• Difficulty exercising
• Psychological symptoms, such as being self-conscious about the chest appearance and avoiding activities where the chest can be seen.

How do we diagnose pectus excavatum?

Each patient diagnosed with pectus excavatum undergoes a thorough history and physical examination. Our team developed new ways to measure and assess chest wall deformities. We measure the chest with a simple caliper (like a ruler) that allows us to measure the degree the chest is sunken in the middle compared to the most anterior part of the chest. This is described as the “Modified Percent Depth” and a measurement larger than 11% may indicate a severe depression. The benefit of this measurement includes it can be repeated over time to monitor the progression and may avoid costly and time-consuming radiographic studies as well as possible radiation exposure.

Some children, however, may still need computed tomography (CT) scans or magnetic resonance imaging (MRIs) prior to their procedure that your surgeon will review with you. A comprehensive pre-operative evaluation often includes cardiac and pulmonary testing.

Our Approach to Pectus Excavatum Repair and Recovery

There are several surgical options to correct pectus excavatum. Our experts most often use a minimally invasive repair of pectus excavatum, sometimes called the Nuss procedure.

Minimally invasive repair of pectus excavatum

The procedure involves two small incisions made on each side of the chest. A second small incision is made on the right side of the chest to allow for a scope (small camera) in order for the surgery team to watch the procedure inside the chest. A metal bar spanning the width of the chest is implanted under the sternum in the chest cavity. The bar lifts up the breastbone and corrects the deformity over time. Typically, the bar is left in place for two to three years.

Recovery

Our team has developed a recovery plan focused on patient comfort and a quick return to activity. Our recovery plan avoids use of urinary catheters, epidural catheters, and excessive testing while hospitalized. This plan also minimizes use of narcotics or opioid medications. This recovery pathway has been so successful that the results have been published in scientific medical journals. During in-hospital recovery, our occupational therapists work with patients and families to make sure they are comfortable with managing life activities (getting dressed, showering, getting in and out of bed) once at home. Most patients spend one night in the hospital and are able to resume their full activities, including sports and weight lifting, by three months. Some contact sports might be restricted longer, such as football and hockey and sports that require swinging like golf.

Your child's care team will work with you and your family to make sure you fully understand your child's treatment plan and recovery needs. We have also created helpful videos for you to reference that provide information on discharge and home care instructions, and exercise/movement instructions. Your child's care team is available to answer any questions you may have. 

Pain Management

Our team works very closely with our pain management team to help control postoperative pain. There are many ways to control pain after surgery. For many patients, cryoablation is an effective way at controlling pain while minimizing the need for opioid medications. Cryoablation temporarily freezes the nerves in the chest wall to block pain after surgery. Typically, the chest will feel “numb” or have decreased sensation. These effects last for 12 weeks on average.

Research

The Department of Surgery at Johns Hopkins All Children’s Hospital is active in pectus excavatum research. Our team has led regional and national studies on pectus excavatum diagnosis and repair, and additional topics, including the practice variation of pectus excavatum repair to new methods for determining the severity of chest wall defects.

Call toll-free 800-456-4543 , ext. 4170.