Understanding Adult Pectus Excavatum
Although the majority of individuals with pectus excavatum, or sunken chest, are treated in childhood or adolescence, many adults live with the condition, experiencing a range of symptoms. For some, the primary concern is cosmetic, impacting self-confidence and body image. For others, the condition can cause physical symptoms due to compression of the heart and lungs, such as decreased exercise tolerance, chest pain, and heart palpitations. Unlike childhood, when the chest wall is more flexible, treating adult pectus excavatum can be more complex due to a stiffer rib cage, but it is certainly not impossible.
Surgical Options for Adult Pectus Excavatum
Surgical correction remains the most definitive solution for adults, especially those with moderate to severe symptoms. The two primary procedures available are the Nuss procedure and the modified Ravitch procedure, both of which have been successfully adapted for adult patients. A key consideration for adults is the increased stiffness of the chest wall, which surgeons account for by using more robust techniques, sometimes requiring multiple bars or longer-term support.
The Minimally Invasive Nuss Procedure
Often referred to as MIRPE (Minimally Invasive Repair of Pectus Excavatum), the Nuss procedure is a popular option for adults. During this surgery, a curved metal bar is inserted under the sternum through small incisions on the side of the chest, using a tiny camera (thoracoscope) for guidance. The bar is then flipped to push the sternum outward, correcting the deformity. This bar typically remains in place for two to four years, after which it is removed in a minor outpatient procedure.
Adult-Specific Modifications
- Bar Placement: Adults may require two or more bars to provide enough force to correct the chest wall.
- Recovery: While it is considered minimally invasive, adult recovery often involves a longer hospital stay and more significant pain management than in pediatric patients due to the chest wall's stiffness.
- Potential Complications: As with any surgery, risks exist, though modifications have aimed to reduce complications such as bar displacement.
The Modified Ravitch Procedure
This older, more traditional open surgical approach is still performed today, often for more complex or asymmetrical deformities in adults. The surgeon makes a larger incision across the chest, removes the deformed cartilage connecting the ribs to the sternum, and then repositions the sternum. A metal strut or support may be used to hold the new position, which is typically removed after 6-12 months.
Ravitch Benefits for Adults
- Direct Access: Allows for more direct remodeling of the chest wall, which can be advantageous for stiff or complex cases.
- Long-Term Results: Associated with very low recurrence rates.
- Single Procedure Correction: The reconstruction is finalized during the initial surgery, though a follow-up procedure to remove hardware is common.
Non-Surgical and Cosmetic Approaches
For adults with mild pectus excavatum and no functional symptoms, or those who are not candidates for surgery, alternative treatments focus on improving posture and addressing cosmetic concerns. These options, while not fixing the underlying skeletal structure, can significantly improve quality of life.
Physical Therapy
Regular physical therapy can be beneficial for improving posture, strengthening chest and back muscles, and increasing chest wall expansion. While it won't correct the indentation, it can alleviate some pain and improve overall physical function.
Cosmetic Fillers or Implants
For purely aesthetic concerns, some patients may opt for non-invasive or less invasive cosmetic procedures. Dermal fillers can be used to fill in the sunken area, or in some cases, custom silicone implants can be placed to create a more normal chest contour. These are best suited for mild cases where no heart or lung compression exists.
Choosing the Right Treatment Path
The decision to treat pectus excavatum as an adult is a personal one, depending on the severity of symptoms and the patient's goals. Consulting with a specialist in adult chest wall deformities is crucial to understand all available options. A thorough evaluation, including imaging tests like a CT scan, will help determine the best course of action.
Comparing Adult Pectus Procedures
| Feature | Nuss Procedure (MIRPE) | Modified Ravitch Procedure |
|---|---|---|
| Invasiveness | Minimally invasive | Open surgery |
| Incision Size | Small (side chest) | Larger (center chest) |
| Skeletal Work | No cartilage removal | Removes and reshapes cartilage |
| Hospital Stay | Typically 3-5 days | Variable, can be longer |
| Recovery Time | About 6 weeks, with restrictions | Longer initial recovery |
The Role of Expert Consultation
Given the complexities of adult pectus correction, the surgeon's experience is a major factor in the outcome. Seek out a specialist or program with a dedicated adult chest wall surgery focus. These experts are best equipped to handle the unique challenges presented by a mature chest wall, ensuring the highest chance of success and patient satisfaction.
For more in-depth information, you can visit the Stanford Medicine Adult Chest Wall Surgery Program page.
Conclusion: Hope for Adult Correction
To summarize, adult pectus excavatum is not a condition without remedy. While many were told as children that they would simply have to live with it, modern medicine offers several paths to correction. Whether seeking relief from physical symptoms or addressing cosmetic concerns, options from surgical procedures like the Nuss and Ravitch techniques to non-surgical alternatives like physical therapy are available. The path to a straighter chest and an improved quality of life begins with a comprehensive consultation with a qualified thoracic surgeon.
