There are several treatment options for pectus deformity, ranging from non-surgical options such as psychological support, physiotherapy, bracing and vacuum bell therapy to minimally invasive surgical corrective options such as Nuss, PectusUP or modified Ravitch, otherwise open Ravitch. Cosmetic based implant procedures can also be considered.
Conservative options
Clinical Psychology
Pectus deformities can have a significant impact on body image and quality of life in both adults and children. It is therefore important to acknowledge that support from specialists in psychology may, for some individuals, form an important element of the treatment required with or without other conservative or surgical treatments. This service can be accessed via your GP.
Vacuum Bell Therapy
Vacuum bell therapy is designed for mild forms of pectus excavatum (funnel chest). A suction cup is placed on the sunken area of the chest and a patient activated vacuum device is triggered to gradually correct the deformity. The video below illustrates an example fitting of the vacuum bell therapy system.
→ Vacuum Bell Therapy
Bracing
Bracing techniques are most used often used for pectus carinatum (pigeon chest). Gradual pressure is applied to the protruding breastbone and ribs, which overtime corrects the deformity of the chest wall. This form of treatment often depends on patient age and the maturity of the skeleton. The animation below illustrates an example fitting of the bracing system.
→ Bracing
Physiotherapy
Physiotherapy with a tailored exercise prescription is a recommended adjunct to surgical and non-surgical treatment options for improved functional outcome.
Please note:
The type of device used should be discussed with your thoracic or paediatric surgeon to ensure they meet health and safety standards. As with all interventions, there are risks and benefits associated with conservative treatments. The main risks include damage to skin through abrasion from the devices as well as treatment failure. The benefits include possible correction of the deformity without more invasive surgical intervention. We encourage you to discuss these with your surgeon.
Surgical options
Surgical options can be considered for several reasons which range from cosmetic to functional with impaired exercise tolerance. The following extra tests may be needed:
- Computerised Tomography (CT) Scan or Magnetic resonance Imaging (MRI). This is to assess the shape of the chest in detail and work out the Haller index.
- Electrocardiogram (ECG) and Echocardiogram. This is to check the function of the heart.
- Cardiopulmonary exercise test (CPET)
- Lung function tests
- Marfan’s Risk Calculator
Several surgical techniques (all under general anaesthetic) are available:
The Ravitch or Modified Ravitch procedures
Indication: Asymmetrical Pectus Excavatum or Pectus Carinatum
The Ravitch procedure involves cutting away the cartilages causing the pectus deformity. The breastbone position is then changed (brought forward or pushed back). Sometimes, surgeons may place a small metal bar or mesh to provide additional support. More commonly the patient’s own muscles are used to provide the support.
The video below illustrates the operation (each surgeon may perform a slightly different version of the procedure; this would be discussed in clinic). Please note the video contains graphic images, and parental supervision is advised for viewers under the age of 18.
→ The Ravitch or Modified Ravitch procedures
The Nuss Procedure
Indication: Pectus Excavatum
The Nuss procedure relies on the flexibility of the chest. 2 small cuts are made on the side of the chest. A curved titanium bar is put in to push the breastbone forwards. The bar then stays in place to support the new shape for 2 to 3 years before being removed in a second operation. Sometimes 2 or 3 bars are needed. The bar is put in under the skin and behind the breastbone. A small camera is used to guide the bar as it is put in the chest. The ‘u‘ shaped bar is flipped to an ‘n’ position to push the breastbone forward. No cartilage is removed or cut. This procedure is less invasive than the Ravitch procedure.
A second operation is needed to remove the bar(s). The Nuss procedure is less effective at correcting asymmetrical deformities, which are likely to still be present after the procedure. The animation below illustrates an example of the Nuss procedure (your surgeon may perform a slightly different version of the procedure; this would be discussed with you in clinic).
→ Nuss Procedure
Pectus-Up
Indication: Pectus Excavatum
Pectus-Up also known as Taulinoplasty is a relatively newer technique that uses a plate-like implant or prosthesis and a sternal tractor screw. Together they are used to raise the sternum to the desired position. The video below illustrates the surgery (each surgeon may perform a slightly different version of the procedure; this would be discussed in clinic).
Please note the video contains graphic images, and parental supervision is advised for viewers under the age of 18.
→ Pectus Up
Anatomical Implant Procedure
Indication: Pectus Excavatum
For pectus excavatum with normal exercise tolerance, pectus implants can be used as an alternative to more invasive procedures. It involves inserting an implant into a pectus excavatum defect, which sits under the skin. The video below demonstrates the operation. (each surgeon may perform a slightly different version of the procedure; this would be discussed in clinic).
Please note the video contains graphic images, and parental supervision is advised for viewers under the age of 18.
→ Anatomical Implant Procedure
It is important to note that the availability of each of these procedures, particularly Pectus-Up and anatomical implants vary depending on the local health service provider.
It is important to note that the availability of each of these procedures, particularly Pectus-Up and anatomical implants vary depending on the local health service provider.