FUNNEL CHEST TREATMENT OR PECTUS EXCAVATUM

Pectus excavatum or sunken chest is a congenital chest abnormality present at birth. It is the most common chest wall deformity that affects 1 to 2 % of the population (1 case in 3 00 births to 1 case in 1000 births).

Its main characteristic is a depression of the sternum, in the middle of the chest or on the side, that gives a caved-in, funnel-shaped appearance to the chest.

It may occur in men and in women.

Many patients with this condition do not know that it may be treated.

Yes, as classified by Chin:

• Type 1: the malformation is symmetrical and narrow
• Type 2: the malformation is symmetrical and large
• Type 3: the malformation is asymmetrical and on one side only.

For decades, thoracic surgeons have performed sterno-chondroplasties to entirely restructure ribs and sternum position structurally, either by turning the sternum over (Ravitch technique) or by fixing surgical metal bars through thoracoscopy (Nuss procedure). Both techniques are invasive and involved morbidity, complications and visible scars.

Today, since absence of functional, cardiac and respiratory effects has been proven, filling procedures are used to treat this funnel: with lipofilling (injection of fat) for mild deformities and patients who have enough fat stock, or with a custom-made implant (with computer-aided design from a patient’s CT scan) for more severe ones.

These technical innovations provide a successful and minimally invasive treatment with less risks of complications. The procedure is quick, the recovery simple and the scars are reduced.

• Two preoperative consultations with a board-certified plastic surgeon will be conducted as well as a consultation with an anesthetist.
• Before and after comparison photographs will be taken.
• A post-surgical compression garment, will be prescribed.
• Preoperative instructions are as follow:
  • Quit smoking at least one month before the surgery and up to 1 month after the surgery to avoid any complication or necrosis risk.
  • Discontinue any anti-platelet or blood-thinning medication 15 days before the surgery.

• It is performed under general anesthesia.
• It lasts about 1 hour.
• Dr Vincent Nguyen uses the most advanced surgery techniques that avoid the use of drains, and performs the surgery himself.

• This chest surgery is not a painful surgery. Only light analgesics will be prescribed.
• Patients may go home the following day or 2 days after the procedure.
• Swelling and bruising appear on the chest the following days.
• No nursing care is required after the surgery.
• You may have a shower the day following the surgery but you can’t have a bath before a month.
• All sutures are made with absorbable material and under the skin, it is not necessary to take them off.
• The compression garment must be worn night and day for 6 weeks to avoid bad scarring.
• Avoid sun on the scars for at least a year.
• Most patients may go back to work 15 days after the surgery, depending on the nature of their job.
• You may resume physical activities after 3 months.
• Follow-up consultations with Dr Vincent Nguyen will be scheduled (1 week, 1 month, 3 months, 6 months and a year after the surgery).

The chest implant is made of solid silicone, not of gel silicone. It is a highly stable material which doesn’t degrade and has an unlimited life span. The implant won’t have to be replaced.

Custom-made implant conforms to the patient’s unique morphology and defects. The implant is invisible and the esthetic benefits are immediate.

The physical improvement is immediate and requires only one procedure.

Compared with previous procedures, these new procedures are less invasive and less drastic than orthopedic surgeries (Nuss, Ravitch). The patient only stays 1 to 3 days in the hospital. The risks of complications and comorbidity are reduced.

These procedure are less painful. Patients may go back to work after 2 weeks and may resume sport activities after 3 months. The result remains stable over time and permanent.

The scars depend on the chest malformation. Usually there is a scar below the breast or in the sternum. The scars fade over time and they become almost invisible.

Women with pectus excavatum often complain about bust deformity, breast asymmetry, drooping breast strabism. This may cause specialists not diagnose a funnel chest deformity and, in that case only the breasts are addressed. But only the treatment of the chest will improve the alleged breast defect.

Besides the invasive surgical orthopedic procedures, lipofilling may be an alternative to correct a mild defect. But he patient must have enough fat stock.

Lipofilling may be associated with sternal implant procedure. Or there might be a lipofilling later to improve the result.

The last studies tend to demonstrate that it has no effect on cardiac or respiratory functions except when combined with other deformities.

Sometimes, the deformities are such, that patients consider their condition as a physical disability. The psychological impact prevents them from being bare chested in private or in public (swimming-pool, beach, changing room …) and they often have no self-confidence.

Yes, you may have a breast augmentation with implant or with lipofilling after a funnel chest treatment but not at the same time. You will have to wait about 6 months after the first procedure.

Yes, it is very common now to have a custom-made implant procedure if the results of the first procedure are not fully satisfying.

As it is customized, the implant conforms to the chest transformation. The surgeon uses the existing scars and doesn’t make new ones.

It requires about 2 months to have a customized implant made.