What are the treatment options for pectus excavatum and which one is ideal for you?
The right option of treatment for pectus excavatum varies depending on the individual, depending on the severity of the condition and various other factors. This section will cover the different methods of treatment for pectus excavatum and how to choose the best treatment option for you.
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- When should you consider surgery for pectus excavatum?
- What is the primary goal of surgery for pectus excavatum?
- The surgery methods for pectus excavatum
- Nuss Procedure
- Ravitch Procedure
- Implant Surgery
- When are non-surgical treatments for pectus excavatum suitable?
- Non-surgical treatments for pectus excavatum
- Exercises
- Vacuum Bell Therapy
- Choosing a treatment option for pectus excavatum
- What are the common complications associated with pectus excavatum surgery?
- Is pectus excavatum surgery available on the NHS?
When should you consider surgery for pectus excavatum?
If you are self-conscious of your chest or any features typical with pectus excavatum, surgery is an excellent way to improve your self-esteem.
Pectus surgery is usually offered to individuals with moderate to severe pectus excavatum, rather than those experiencing mild symptoms. However, implant surgery can be ideal when your wellbeing is affected, but your condition causes no functional problems.
What is the primary goal of surgery for pectus excavatum?
The primary purpose of surgery for pectus excavatum is to correct the chest deformity. If the sternum is repositioned to a more normal outward position, this will improve the shape of your chest. This correction may improve a patient’s breathing and cardiac function in some cases. However, there is still not enough evidence to suggest that this is guaranteed.
Surgery also addresses psychological problems, as the appearance of the chest is also improved.
The majority of patients who have corrective surgery for pectus excavatum experience positive results (source).
The surgery methods for pectus excavatum
Nuss procedure
A tiny camera is inserted into the chest to guide the procedure. The procedure consists of the following steps:
- The surgeon makes two small incisions into either side of the chest.
- The surgeon inserts a metal bar, often known as a “pectus bar” through an incision on each side of your chest. Once the bar is inside, the surgeon flips it over, forcing the sternum outwards to improve the chest wall deformity.
- A metal plate (called a stabilizer), sutures (stitches), or wire will be placed to hold the bars in place.
The bar must stay in place for at least three years, depending on age and the severity of your condition. Depending on your situation, the steel bars might need to remain there permanently, which means you don’t have to undergo a second procedure to have them taken out. Otherwise, you would have the bars removed.
The Nuss procedure can be more challenging to carry out on adults than children (source).
When should you expect to see results?
Most people see results around three months.
How long is the recovery process?
You can expect to resume all usual activities within approximately three months.
When is the bar removed?
Three to five years after insertion (if the surgeon decides not to leave it permanently in place).
Ravitch procedure
The Ravitch procedure is often known as the “traditional” surgical repair for pectus excavatum. During the surgical procedure:
- opens your chest to access your sternum and ribs
- removes small sections of chest cartilage
- repositions the ribs and sternum
- uses steel bars to hold the sternum and ribs in place
The Ravitch procedure is the most invasive surgical correction method for treating pectus excavatum and is sometimes called “open surgical repair”.
When can you expect to see results?
Most people see results after around three months.
How long is the recovery process?
You can expect to resume all usual activities within three months.
When is the bar removed?
1–2 years after insertion (if the surgeon decides not to leave it permanently in place).
Implant surgery
Implant surgery is a less invasive and safer repair method compared to the Nuss procedures and Ravitch procedures. If you don’t experience severe symptoms associated with the condition but are not happy with the appearance of your sternum and rib cage, you may be an ideal candidate for implant surgery.
The surgeon will insert the implant below the pectoral muscles and tapers the edges, so they smooth over the sternum and ribs. The implant is custom-made for your anatomy and will fit perfectly. This means it won’t be uncomfortable or irritating. It will also be completely undetectable. This procedure is planned as a lifelong pectus excavatum correction.
You can read more about pectus excavatum implant surgery here.
What is the implant made of?
In implant surgery, a purpose built implant is produced to replicate the missing contour of the ribs, giving a more normal appearance of the chest. In females, it provides a more normal breast shape and symmetry.
You will first have a CT scan. This takes x-ray images of the inside of your body. The data from your CT scan will be used to create a 3D computer model of your torso, which is identical to your anatomy. Your implant will then be made by implant manufacturing specialist SEBBIN. Once the design is complete, your surgeon will confirm that it is correct, and the manufacturer will create your implant. The manufacturer will produce the implant from silicone rubber and deliver it to your surgeon.
You can read more about implants in our guide pectus excavatum silicone implants: what they are and how they’re made.
When can you expect to see results?
The deformity will disappear immediately after surgery. Usually, pectus excavatum patients will see full results after around 2 to 3 months. By this time, any swelling or bruising will often have gone.
How long is the recovery process?
You can expect to resume all usual activity within 4 to 6 weeks.
You can find out more about what to expect when recovering from pectus excavatum implant surgery here.
Non-surgical treatments for pectus excavatum deformity
Exercises
Strengthening and stretching the core muscles can help with rib flare caused by pectus excavatum in some individuals.
As an option for pectus excavatum treatment without surgery, exercise is a non-invasive, natural option for treating the condition. However, exercise cannot cure pectus excavatum. There is also no guarantee that it can improve pectus excavatum and other chest wall anomalies.
You can read about the types of exercises to practise here.
When can you expect to see results?
A patient who suffers from a mild case of pectus excavatum will start to see a slight improvement in a few months. It usually takes a minimum of around four weeks to see a small muscle-building response in the muscles. To see a change in ligaments and cartilage, you’re looking at approximately 20 weeks (source). Often, the condition does not entirely resolve. It is vital to keep up with the exercises to ensure you get the best results.
Vacuum bell therapy
Vacuum bell therapy is primarily used for children and adolescents, as young sternums and ribs are still growing, so they are more flexible. During vacuum bell therapy, a suction cup is placed over the sunken area of the chest. The patient then uses a hand pump to suck the air out of the suction cup and create a vacuum. This will cause the chest wall to rise. Once the chest wall has risen, you can remove the hand pump and plug the end of the tubing to form a seal. You can then leave the device in place for the amount of time recommended by your healthcare practitioner.
You can read more about vacuum bell therapy here.
When can you expect to see results?
Over a period, which could be a year or more, some patients find that their pectus deformity shows signs of permanent improvement. However, for others, the chest will sink again as soon as the device is removed.
The results of vacuum bell therapy will depend on your age and the severity of your pectus excavatum. Vacuum bell therapy is unlikely to have successful effects in adults with severe pectus excavatum. There are also no studies that prove this treatment has long term success in adults.
Choosing a treatment option for pectus excavatum
The right treatment method for you depends on the severity of your case, your budget, the advantages of each technique and other preferences. We recommend talking to your GP about your symptoms and circumstance before choosing a treatment option. You can use the below comparisons and guides to help you compare each treatment option:
Non-surgical options vs surgery
For mild cases of pectus excavatum: If you have mild pectus excavatum, you can practice exercises as a natural treatment method. Vacuum bell treatment could also be an option for you. However, there are no clinical studies that prove this treatment has long-term success in adults. If you feel your pectus excavatum is affecting your confidence and wellbeing, implant surgery has a higher success rate and may be suitable for you. Implant surgery is ideal for people who feel their condition is not causing functional problems, but who are self-conscious of their appearance.
For moderate to severe pectus excavatum: Surgery is the most effective method for treating pectus excavatum. It is also more likely to effectively manage pectus excavatum.
Costs of surgery methods
As a rough guide, you can expect to pay the following for pectus excavatum repair:
- The Nuss procedure: upwards of £32,000 (source).
- The Ravitch procedure: speak to your practitioner
- Implant surgery: £6,000–£11,000
It is worth bearing in mind that the Nuss and Ravitch procedure also expensive and, in many cases, unlikely to be funded by the NHS.
The hospital stay for each surgery method
| Nuss | Ravitch | Implant | |
|---|---|---|---|
| Hospital stay | Approx. 4 days | Approx. 5 days | 1–2 days |
Expected time before seeing results
| Implant | Nuss | Ravitch | Vacuum Bell | Exercises | |
|---|---|---|---|---|---|
| When can you expect to see results? | Main deformity gone with surgery. Around 3 months to settle | Main deformity gone with surgery. Around 3 months to settle | Main deformity gone with surgery. Normally, patients will see results after around two to three months. | Over a period, which could be a year or more, some patients find that their pectus excavatum shows signs of permanent improvement. | To see a change in ligaments and cartilage, you’re looking at around 20 weeks (source). |
What are the common complications associated with pectus excavatum surgery?
The Nuss and Ravitch procedures are invasive surgeries which have associated risks. The Nuss and Ravitch procedures are invasive surgeries which have associated risks. The risk of major complication is much lower in implant based surgery.
You can read about the risks and complications associated with pectus excavatum surgery here.
Is pectus excavatum surgery available on the NHS?
The implant procedure is not currently available on the NHS in most areas.
Invasive surgery to correct pectus excavatum is not available on the NHS either, unless the deformity has been shown to cause significant issues with your heart or lungs.
You should always speak to your GP about your symptoms or if you have any concerns about pectus excavatum.
If you want to find out more about pectus excavatum implant surgery, read our guide Pectus excavatum implant surgery: explaining the procedure, results and cost or contact Stephen McCulley today by phone on 0115 962 4535 or by email at enquiries@stephenmcculley.co.uk.