Chest Wall Deformity: More Common Than You Think
Nearly one in 1,000 children has a chest wall deformity. Here's what you need to know about treatment.
Now that the weather is getting warmer, pediatric surgeons are seeing an increase in referrals to correct a surprisingly common but little-discussed condition: chest wall deformity.
The appearance of chest wall deformities can vary: the condition is either “sunken in” (officially known as Pectus Excavatum) or “sticking out” (Pectus Carinatum). Unless the case is severe, you may not even notice it until you see your child without a shirt. Often, such deformities are milder in the early years and do not become pronounced until children hit growth spurts in their late adolescent and teen years. Personally, I dislike referring to these conditions as “deformities.” The negative connotations are not warranted. These conditions are frequent enough to occur in one out of every 1000 children, and commonly require no treatment.
Pectus Excavatum affects the sternum (breastbone) and the cartilage that connects the sternum to the ribs. The abnormal growth of the cartilage results in an indentation in the middle of the chest. The condition has a wide range of severity, from a very mild depression to a severely sunken chest. Depending upon the severity, patients with Pectus Excavatum may have no physical symptoms or may have shortness of breath during exercise, as well as chest pain and/or palpitations. This is due to compression of the heart and lungs by the more severe indentations.
We encourage all families to consult with a pediatric surgeon. Surgical repair is a major decision and education is essential. During surgery, a metal bar is inserted into the chest to raise the breastbone and allow the cartilage to regrow and solidify into a more normal shape (usually in one to three years). The bar is then removed with an additional minor procedure. Insurance carriers frequently require additional studies before approving surgery.
Pectus Carinatum is the result of the sternum and cartilage protruding. Frequently referred to as “bird chest,” Pectus Carinatum is less common than Pectus Excavatum. When Pectus Carinatum becomes more pronounced after a growth spurt, it may be painful, and the protrusion may be noticeable through a child’s clothing. Nonoperative treatment options exist with appropriate referrals.
It is important to emphasize that these conditions are not life threatening, but for children who deal with either, the psychological toll on their body image and confidence can be profound. We often see children, especially boys, who become very self-conscious about their condition. They may avoid sports or activities where they might need to undress in a communal space, and tend to stay away from beach trips and pool parties. Girls going through puberty may struggle with what appears to asymmetrical breast development, when the problem is really with the underlying chest wall.
For those children whose condition is relatively mild and does not limit them physically, surgery is not necessary. I am often impressed with children who choose to “own” their condition. If others stare or ask questions, these children use this as an educational opportunity to explain chest wall deformity and how common it is.
For those families considering surgery, summer is the time to do it. The hospital stay for surgery (especially for Pectus Excavatum) is typically four to five days, and physical activity is highly restricted for an extended period of time.