Understanding Pectus Excavatum
Pectus excavatum is a condition where an abnormal growth of cartilage causes the breastbone (sternum) and ribs to grow inward, giving the chest a sunken appearance. While it is often present at birth, it can become more pronounced during adolescent growth spurts. The condition varies widely in severity. Mild cases may cause no symptoms beyond cosmetic concerns, but moderate-to-severe cases can compress the heart and lungs, leading to physical symptoms such as shortness of breath, chest pain, and fatigue, especially during exercise. The psychological impact, including self-consciousness and social anxiety, is also a significant concern for many individuals.
Causes and Associated Conditions
Although the exact cause of pectus excavatum is unknown, there is often a genetic link, as it can run in families. In some cases, it is associated with connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome. Diagnosis is typically made through a physical exam and imaging tests, like a CT scan, which can measure the severity of the indentation and assess potential heart and lung compression.
Non-Surgical Options for Correcting a Sunken Sternum
Not all cases require surgical intervention. For those with mild-to-moderate pectus excavatum, especially younger patients with flexible chests, non-surgical methods can be effective. These treatments focus on gradual correction and symptom management.
Vacuum Bell Therapy
Vacuum bell therapy uses a suction cup-like device worn on the chest to create a vacuum seal, gently pulling the sternum forward over time.
- Who is it for? Best for younger patients with mild defects and a flexible chest wall. It is generally not recommended for severe cases or older adults with a more rigid chest.
- How it works: The device is worn for several hours a day over a period of many months, or even years. Consistent use is crucial for success.
- Key considerations: While typically not painful, some patients may feel pressure. It requires significant commitment and the chest wall's flexibility plays a large role in the final outcome.
Physical Therapy and Exercise
Physical therapy cannot 'cure' pectus excavatum, but it can significantly improve posture, strengthen chest and back muscles, and increase lung capacity.
- Stretching and Postural Exercises: Targeted exercises can help increase the mobility of the chest wall and improve overall posture, which may minimize the appearance of the condition.
- Breathing Exercises: Deep breathing exercises, particularly diaphragmatic breathing, can expand the rib cage and reduce associated chest tightness.
- Building Muscle: Strengthening the pectoral and back muscles through exercises like push-ups and swimming can help improve the aesthetic appearance by building muscle mass around the deformity.
Surgical Options for Significant Correction
For moderate-to-severe cases, or when non-surgical methods are unsuccessful, surgery offers a more definitive correction. This is often recommended when symptoms like shortness of breath or heart compression are present, or when the psychological impact is severe.
Nuss Procedure (Minimally Invasive Repair of Pectus Excavatum)
This is the most common surgical technique for correcting pectus excavatum.
- Procedure: The surgeon makes small incisions on each side of the chest. A fiber-optic camera guides the placement of a curved metal bar threaded under the sternum.
- Correction: The bar is then rotated to push the sternum into a more normal position.
- Recovery: The bar typically remains in place for two to three years before being removed during a minor outpatient procedure.
Ravitch Procedure (Open Repair)
This is an older, more invasive technique, sometimes used for complex or asymmetrical cases.
- Procedure: A larger incision is made down the center of the chest. The surgeon removes the deformed cartilage, and the sternum is repositioned.
- Support: A metal strut or other hardware may be used to hold the sternum in place, which is removed later.
Cosmetic Filler Options
For mild cases where functional problems are absent, cosmetic alternatives can be considered.
- Implants: Custom-made silicone implants can be used to fill the sunken area, offering an immediate cosmetic improvement.
- Lipofilling: This involves transferring fat from another part of the patient's body to fill the chest depression. Multiple sessions may be required.
Comparing Non-Surgical vs. Surgical Treatments
| Feature | Non-Surgical Methods (e.g., Vacuum Bell, PT) | Surgical Methods (e.g., Nuss, Ravitch) |
|---|---|---|
| Effectiveness | Best for mild cases; can improve posture and muscle strength, but may not fully correct the deformity. | Provides definitive and often dramatic correction, especially for moderate-to-severe cases. |
| Invasiveness | Non-invasive and low risk. | Invasive; carries risks associated with surgery, including pain and infection. |
| Recovery Time | No significant downtime, though therapy requires consistent effort over a long period. | Requires a hospital stay and a multi-month recovery period. Bar removal is a second procedure. |
| Ideal Candidate | Young patients with mild, flexible chest walls; individuals with cosmetic concerns only. | Older patients, severe deformities, or those experiencing heart/lung compression. |
| Cost | Generally lower upfront cost, but may involve purchasing equipment and long-term physical therapy expenses. | Higher upfront cost due to surgery, but may be covered by insurance if functional issues exist. |
Which Method is Right for You?
Choosing the right treatment for a sunken sternum depends on various factors, including the severity of the condition, presence of physical symptoms, age, and personal goals. For mild, purely cosmetic concerns, non-surgical options offer a safe starting point. However, if the condition affects cardiopulmonary function or causes significant psychological distress, surgical correction often provides the most complete and lasting solution. A specialist evaluation is essential to determine the best course of action. For more information on chest wall deformities and related health topics, consult authoritative medical resources such as the National Institutes of Health.
Conclusion
The question of how to lift sternum is best answered by seeking a professional medical evaluation to determine the underlying cause and severity of the condition. While simple exercises can improve posture and muscle tone, they cannot physically correct a congenital chest wall deformity. Effective treatments, ranging from non-invasive vacuum bell therapy to definitive surgical correction, exist to address both the physical symptoms and psychological effects of the condition. With the right approach, individuals can achieve significant cosmetic and functional improvements, leading to a better quality of life.
Key takeaways
Pectus excavatum is a congenital condition: It is the most common congenital chest wall deformity, involving an inward growth of the sternum and ribs. Non-surgical options exist for mild cases: Treatments like vacuum bell therapy and physical therapy can help improve posture and appearance in less severe cases, especially in younger patients. Surgery offers definitive correction: For moderate-to-severe pectus excavatum, the Nuss and Ravitch procedures can correct the deformity and alleviate symptoms related to heart and lung compression. Symptoms can be physical and psychological: The condition can cause shortness of breath and chest pain in severe cases, as well as significant self-consciousness and anxiety. Consult a specialist for proper diagnosis: A thorough medical evaluation, including imaging tests, is necessary to determine the severity and the most appropriate treatment plan. A specialist is crucial for determining treatment: The best method to lift the sternum depends on severity, physical symptoms, and age, highlighting the need for expert medical advice. Modern surgical techniques have improved: Procedures like the Nuss procedure are minimally invasive with high patient satisfaction and improved outcomes over older methods.
