Chest Wall Deformities

We provide a comprehensive evaluation and treatment of birth defects such as funnel chest (Pectus excavatum) and pigeon chest (Pectus carinatum), using minimally invasive surgical techniques and non-surgical treatments.

practicemanagement@marcoscarci.co.uk

02074594367

Overview

Chest deformities affect around one-in-400 people and usually become more severe during adolescence. Some patients complain of chest pain and may undergo many investigations without any cause for their symptoms being found.

Our multidisciplinary team includes specialist thoracic nurses, anaesthetists, occupational and physical therapists. Any chest x-rays or other images required are examined by a dedicated specialist thoracic radiologist.

Our minimally invasive surgical techniques reduce scarring and we have developed very effective ways of minimising pain and using physical therapy to help patients return to normal activities more quickly. You will receive detailed advice on any necessary restrictions after treatment.

Funnel Chest (Pectus excavatum)

Surgical correction: Mr Marco Scarci is experienced in minimally invasive surgery (called the Nuss procedure) for treating both children and adults.

Carried out using an epidural for pain control.
Two incisions either side of the breastbone and a curved steel support bar inserted under the breastbone and fixed to the ribs. This stays in place for 2–3 years.
Hospital stay: 4–5 days.
Follow-up with Mr Scarci: at 2 weeks, one month, three months, and six months after the operation.
Removal of the support bar: 2–3 years later as a day-case operation under a quick general anaesthetic.

Non-surgical correction: In young patients with a flexible chest and symmetric defect we get good results using a vacuum bell device that literally ‘sucks’ the chest up. The device needs to be worn for several hours every day.

We have the expertise to achieve excellent results correcting even the most complex deformity, using the vacuum bell as part of a combined surgical and non-surgical treatment.

Pigeon Chest (Pectus carinatum)

Surgical correction: An incision is made across the chest and the overgrowth of cartilage between the ribs and breastbone is removed. The breastbone is then placed in the usual flat position, with titanium bars sometimes used to stabilize the chest.

Hospital stay: 2–3 days.
Recovery: a thin soft corset, barely visible under clothes, is worn around the chest for the first few weeks. Patients can usually resume all normal activities within three months.

Non-surgical correction: Mr Scarci would be very happy to discuss options and suggest the very best and most appropriate treatment for your child. Rather than a ‘one size fits all’ solution, we use the latest model of custom-made pectus brace, which has many important benefits:

Applies pressure on exactly the most prominent part of the breastbone, for maximum effectiveness.
Designed to be barely noticeable under normal clothes –particularly appreciated by younger patients in school.
Can be customized perfectly to treat even asymmetric defects.
Allows us to measure accurately the pressure needed to achieve correction, without being too tight and uncomfortable, or too loose to provide any correction.
Shorter treatment time and much lower failure rate than with other brace designs.

FAQs About Chest Wall Deformity

What are the different types of chest wall deformities types?

There are different types of congenital chest wall deformities. The most commons is the pectus excavatum, also called in simpler terms funnel chest. In this condition the anterior portion of the chest sinks in and forms like a funnel. There are different variant of it according to the severity of the deformity (mild- moderate and severe) and the shape of it. Some can involve just the bottom part of the chest others the entire breast bone, sometime the defect is wide and long and takes the name of grand-canyon variant. This deformity affects nearly 2/3 of all patients and is more prevalent in males. Another common variant is the pectus carinatum or also called pigeon chest. In this condition the breastbone sticks forward like the bow of a ship. It also has different grades of severity and sometime it can also be visible under clothes. This condition affects about the remaining 1/3 of the cases. Lastly there is a rare variant called pectus arcuatum which is a combination of the two previously mentioned defects. Very often this is wrongly diagnosed as pectus excavatum as the chest does sink in, but, more importantly, it also sticks out. It is very important to be familiar with this condition and having diagnosed properly as the wrong diagnosis might lead to the wrong treatment.

What are the common chest wall deformity symptoms?

Symptoms varies greatly according to the type and severity of the defect. Some patients with a mild conditions have no physical symptoms at all or are very mildly symptomatic. Others with severe defects can experience shortness of breath and pain along the anterior rib cage, especially after exercise. This pain is quite non-specific and it is mostly related to an asymmetry in the rib cage that responds differently to mechanical stress. Shortness of breath is also rather common, but, unfortunately, it is difficult to diagnose it as most patients are young and fit at rest. The problems only become evident during sub-maximal exercise. In this category of patients a cardiopulmonary exercise test might be the best way forward to document the symptoms. Static lung function is not useful in this scenario, nor is a standard chest x-ray.

Chest Wall Deformities