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Surgery for pectus deformities

What is a pectus deformity? 

These are abnormalities of the bones and cartilageof the front of the chest. In the commonest pattern, pectus excavatum, the breast bone or sternum sinks inwards leaving a large 'dimple' in the front of the chest. This is sometimes known as 'funnel chest'.  Alternatively, the breast bone can be pushed outwards, known as pectus carinatum or 'pigeon chest'. Other patterns, for example where one side projects outwards and the other inwards, are also possible.  Lastly, syndromes such as Poland's syndrome can be reconstructed using surgical techniques similar to pectus deformities. 

These conditions can develop in early childhood, but often become more prominent around puberty. 

These pages can't provide medical advice, as everyone is different. We do hope that they provide some background information, to help patients and families understand pectus deformities in general terms. 

What causes pectus deformities? 

Both men and women can develop pectus, but it is more common in men. It is a little more common in people who have a family member with the condition. Some are related to severe curvature of the spine, or to genetic conditions such as Marfan's syndrome.    However, for most people there is no obvious cause, and they are otherwise fit and well.    

Does everyone with a pectus deformity need surgery? 

No. Some very severe pectus excavatum patients may have a reduction in their ability to exercise, and this might be improved by surgery. However, the condition is not life threatening. Sometimes it can occur together with other conditions (for example curvature of the spine) which do need treatment. We don't think anyone should feel that they 'need' surgery - it is their decision. Patients who are not troubled by their pectus should probably leave it alone. 

Many people have a mild form of pectus, and probably won't benefit from repair overall, once the inconvenience of an operation and the scars needed are taken into account.   

Pectus patients can feel very self conscious about their chest, and this can lead to reluctance to exercise or undertake other normal activities.  When these problems become severe, corrective surgery can often restore quality of life. 

Is this surgery common? 

In 2010, 274 pectus operations were performed across the UK and Ireland, according to the Society for Cardiothoracic Surgery National Audit Report, In Bristol, 20-25 of these operations are performed every year. 

When is the best age to have pectus surgery? 

Units around the world have reported good results with surgery at ages from young children to adults. Our own preference is to perform surgery in the teenage years or young adulthood if possible. This allows patients to think about surgery and to be fully involved in the decision.    

Some people who underwent surgery as children have reported partial recurrence of their pectus as they went through puberty. There have been very rare reports of abnormal bone growth after repair in early childhood. These are not issues in patients who are fully or nearly fully grown.   

Coming to clinicBCH

It is always useful to bring family members or a friend. If you are under sixteen we will need your parent or guardian to come with you.  Feel free to ask any questions that you have. Sometimes it helps to write these down before you come. 

You will meet a member of the surgical team, who will ask you questions and examine you. X-rays or other tests may be ordered. If we think that you need investigated for another condition, we may ask other specialists to see you in their clinics before making a decision on surgery. 

Usually we will ask you to have photographs taken for your medical notes. You will be asked to sign a separate consent form for this. 

If you and your team decide that surgery might help you, you (or your parent if under 16) will be asked to sign a consent form. This says that you agree to have the surgery, you understand what it involves, how it might help and what the risks might be. You can ask for a copy of this form to take home. 

Patients who are listed for surgery will need to attend the pre-operative assessment clinic (POAC) after their clinic visit. 

The final decision about surgery will always be for you and your family to make.