Your step-by-step guide to pectus excavatum implant surgery

Pectus excavatum is a condition that causes the sternum to bend inwards so the chest appears sunken. In many cases the condition can cause the rib cage to appear flared as well.

Although most people with the condition don’t experience any adverse symptoms, in severe cases, pectus excavatum can cause problems with heart and lung function.

If you don’t experience any symptoms associated with the condition, but are not happy with how your sternum looks, you could be a good candidate for pectus excavatum implant surgery.

You can find out more general information about pectus excavatum implant surgery here, or read on for specific information about what the procedure involves.

Below we look at the different stages of pectus excavatum implant surgery:

What happens before the surgery?

Health status

Before having any surgery, it’s a good idea to make sure you’re in the best possible health. Prior to your operation, you’ll need to have a BMI of below 30 to avoid potential complications with the anaesthetic used during surgery.

You are advised to stop smoking for at least six weeks before surgery and also stop taking any herbal medicine at least four weeks before the procedure.

You’ll also need to stop taking anti-inflammatory medication 10 days before surgery. You might need to stop taking other medication as well, so it’s vital to tell your surgeon what medication you’re taking well before the operation.

Packing your hospital bag and arranging transport home

It’s likely you’ll be in some pain and have some restricted movement after the operation, so you’ll need to prepare for how you’ll deal with this.

It is best to book two weeks off work, or longer if you have a particularly strenuous job. It is also a good idea to arrange for a friend or family member to pick you up from the hospital and stay with you for a few days if you live on your own.

Most pectus excavatum implant surgeries are day cases or a single night hospital stay.

This means you’ll have to pack an overnight hospital bag. Useful things to pack in your hospital bag include:

Loose, comfortable clothing.
Slippers and a dressing gown.
Something to keep yourself entertained such as books, magazines, a tablet and your phone and charger.
Wet wipes, moisturiser and lip balm.
A water bottle with a straw, in case you find sitting up difficult at first.
Snacksfor after the procedure—it’s likely you won’t be able to eat anything before having surgery.
Pyjamas and toiletries in case you have to stay in the clinic overnight.

Pre-surgical checks

You’ll need to have several health assessments before having pectus excavatum implant surgery.

Pectus excavatum symptoms checks

If you’ve experienced any symptoms related to pectus excavatum, you’ll need a thorough examination to check for any heart or lung problems.

Most people who have pectus excavatum don’t have any symptoms, but it’s still advisable to have a full examination before having implant surgery, to rule out any underlying health concerns.

Symptoms can include:

chest pain
tiredness, particularly when exercising
heart palpitations

If you’re experiencing symptoms of pectus excavatum then your GP should be able to refer you to a specialist. If you don’t have any symptoms then speak to your surgeon for advice—you may have to have the tests done privately.

Custom-made implant tests

Your surgeon will perform a CT scan on the entire chest area, including your upper arms and back, to determine the size and shape of the indent in your chest. This data allows your surgeon to produce a computer-aided design (CAD) image of your sternum and ribs and create a custom-made implant that fits your chest exactly.

The implant is made of medical-grade silicone, elastomer or rubber. It’s extremely durableand is designed to be retained for life.

The implant is firm at the centre to recreate the feeling of bone and gradually tapers out towards the edges—the edges are so thin and smooth they can’t be seen or felt through the skin.

You can find out more about the implants used in pectus excavatum procedures here.

Pre-op assessment

As with any surgical procedure, you’ll need to have a full pre-op assessment before having surgery. Pre-op assessments are usually performed by a nurse in the clinic where you’ll have your operation.

You’ll be asked a series of questions covering your medical history, what medication you’re taking and your general health. You may also have tests such as a blood test and you’ll usually have your blood pressure taken. Your individual circumstances will determine the tests you have done.

What happens on the day of your pectus excavatum implant surgery?

Meeting your nurse

On the day of your surgery, you’ll be asked to arrive at the clinic in plenty of time as you’ll need to fill in paperwork to be admitted into the clinic.

Your nurse will then show you to your private room and give you a hospital gown. You’ll be able to store your belongings in a locker in your room.

You’ll need to remove any jewellery, glasses and contact lenses before the procedure.

Your nurse may then ask you questions about your health and do tests, such as taking your blood pressure, to check you’re in good health.

Meeting the surgeon and anaesthetist

Once you’ve been admitted and have had the chance to settle in, you’ll see your surgeon and anaesthetist. This is a great opportunity to ask any further questions you might have.

As the surgery is done under general anaesthetic, the anaesthetist willexplain what will happen during the operation and talk you through the risks of having general anaesthetic. You’ll then be asked to sign a consent form.

Your surgeon will then use a pen to draw where the implant will be inserted and where it will be positioned in your chest.

What happens during pectus excavatum implant surgery?

Once you’re under general anaesthetic, your surgeon will begin the operation. They will make a vertical incision of about 7cm where the indent in the chest is deepest. The surgeon will separate the chest muscle from the sternum and create a ‘pocket’ in which they’ll insert the implant.

As the implant is positioned under the muscles, it’s held securely in place and cannot move or slip out of position.

Once the implant is in place, the surgeon will close the incision and apply a dressing and compression to the area. In most cases, you won’t need a drain. Not having a drain in place can make your hospital stay shorter and reduce the risk of infection.

The operation usually takes an 1-2 hours to complete.

What happens during recovery from pectus excavatum implant surgery?

You’ll be able to leave the clinic the same day of your operation, or the following day, depending on what time you have the procedure done.

Managing the pain

Your surgeon will prescribe you with pain medication. Depending on your level of pain, this could be paracetamol and ibuprofen, or stronger medication in the form of opioids such as codeine.

You’ll probably need to take pain medication for the first three days after the operation, but it’s likely that you’ll still feel sore and may struggle to do certain tasks, such as those which involve raising your arms above your head.Some people can feel sick, tired and generally unwell for a short period of days after having general anaesthetic.

If you live on your own, it’s a good idea to ask a friend or family member to stay with you for a few days while you recover.

Looking after the incision

After the procedure, your surgeon will fit you with a compression garment which should be worn day and night for a month.

It is very common to need the wound to be drained of seroma fluid after surgery and then every eight days until it has healed. The procedure for having a wound drained is known as a puncture. It’s a painless procedure which you may need to have done up to five times. Sometimes the surgeon will use a drain initially which may reduce the times puncture needs to be done. Your surgeon will discuss the advantages and disadvantages of this.

You’ll be able to start doing low-impact physical activities such as cycling or hiking after a month. After three months you’ll be able to return to all your usual activates, including high impact sports, without any issues.

If you have any concerns with how quickly you’re recovering from your procedure, or if you’re finding physical activity difficult, speak to your surgeon.

Potential postoperative complications

As with any surgery, there are potential complications to having a pectus excavatum implant procedure.

Pectus excavatum implant surgery is a minimally invasive procedure and much less invasive than the Nuss or Ravich procedure, so you are unlikely to have any serious complications other than typical swelling and bruising. However, you should be aware of potential complications so you know what to look out for. You can read a full list of complications associated with pectus excavatum implant surgery here.The most common is seroma fluid collection which needs removing with a needle up to five times each week.

Although there are rare postoperative complications associated with the surgery, there are no complications associated with the implant. Unlike implants used for breast augmentations, pectus excavatum implants have no risk of rupture, folding, becoming wavy or suffering capsular contraction—where scar tissue forms around the implant, causing the implant to become distorted. Capsular contraction is one of the most common complications associated with breast implants.

The procedure is planned as a lifelong pectus excavatum correction.

You can find out more about the implants used in pectus excavatum procedures here.

Results you can expect

It will take around two to three months to see the results of your procedure. This is because it can take a while for any bruising or swelling to settle completely.

Any scarring should be minimal and what your scar looks like after a year is likely to be the final result.

You can find out more about the results you can expect from your pectus excavatum implant surgery here.

You can find out more about what’s involved in pectus excavatum implant surgery by visiting the page Pectus excavatum implant surgery: explaining the procedure, results and cost or contacting the clinic today on 0115 962 4535 or email enquiries@stephenmcculley.co.uk.

For more information on other pectus excavatum repair options, including the Nuss and Ravitch procedure, here.

0115 962 4535