The hollowed chest, known scientifically as pectus excavatum , is a congenital malformation in which the sternum bone causes a depression in the center of the chest, in the region between the ribs, causing a change in body image that, although not life-threatening, can hinder the development of self-esteem or cause psychological changes in the child.
The excavated chest can lead to severe complications, such as compression of the organs in the region, which cause the development of respiratory tract infections and difficulty in breathing, making physical exercise difficult and causing pain. This malformation can be seen in conditions such as Marfan's syndrome, Noonan's syndrome, Poland's syndrome and imperfect osteogenesis, for example.
Although the problem can be identified soon after birth, in many cases it worsens with the growth of adolescence and, therefore, treatment is usually only indicated after this period, to reduce the risk of the problem reoccurring. In more rare cases, treatment can also be done in adults, but it is more complicated and time-consuming.
The only way to definitively correct the excavated breast is to have surgery to return the bones to the correct place, so this procedure is indicated mainly in cases where symptoms appear.
How is the surgery done
Surgery to correct the excavated chest can be done in two different ways, depending on the severity and age of the patient. However, in both cases it is done under general anesthesia and it is necessary to stay in the hospital for about 1 week.
The two forms of surgery are:
- Open or Ravitch surgery: it is used in adults, in moderate to severe cases, whose chest is rigid and very asymmetrical and lasts between 4 to 6 hours. In this technique, a horizontal cut is made in the chest to remove the abnormal cartilage that connects the ribs to the sternum bone, allowing the bone to return to its correct position. Then surgical materials are placed to keep the chest in the correct position; Minimally invasive or Nuss surgery: it is usually done on children and in mild to moderate cases and lasts between 1 to 2 hours. In this technique, two small cuts are made under the armpit and then a metal bar is inserted between one cut and another, in order to push the sternum out to the correct position.
This is a very painful surgery and, therefore, after the surgery, it is necessary to stay hospitalized especially to make analgesics directly in the vein and improve comfort, being discharged as soon as the pain decreases and there are no complications.
How is recovery
In the period after discharge, it is necessary to go to frequent consultations with the doctor to do X-rays or CT scans in order to assess whether the sternum is still in the correct position. With these evaluations it is also possible to determine the best time to remove the surgical material or metal bar left during the surgery.
In the case of open surgery, the material is usually removed after 6 to 12 months, while the bar of minimally invasive surgery is removed only after 2 or 3 years.
During this period it is also important to watch for signs of infection or rejection of the surgical material left on the body, such as swelling or redness at the site of cuts, fever above 38ºC or excessive tiredness, for example.
Sports activities, on the other hand, should only be started with the doctor's approval, avoiding those with the greatest impact and risk of injury, such as football, basketball or martial arts.
What are the main causes
The cause of the appearance of the hollow chest is not known, however, it is more common in boys and people who have a family history of the malformation.
Although it does not pose any risk to the child's life, the hollowed chest can manifest itself until adolescence and cause symptoms such as palpitations, coughing, a feeling of pressure in the chest and respiratory infections.
