Find Care Pay My Bill Careers

What Are Chest Wall Deformities

Chest wall deformities are defects in the development of the thoracic cavity (chest cavity), which are either congenital or acquired as a child grows. Some chest wall deformities represent only a cosmetic concern, but some can present with shortness of breath on exertion as well as cardiac arrhythmias and respiratory insufficiency in rare circumstances. Chest wall deformities can impact patients physically, psychologically and socially, so exploring treatment options is important.

Chest Wall Deformities and Disorders

Pectus Excavatum (Sunken Chest)

Pectus excavatum (sunken chest) is the most common chest wall deformity. It is caused when the sternum (breastbone) is abnormally pushed inward due to abnormal cartilage growth that attaches the sternum to the ribs. This can give a bowl or scoop appearance to the chest, or, in some cases, the chest wall appears unequal. Many patients don’t have symptoms, but moderate to severe cases have trouble breathing during exercise and decreased lung capacity. Pectus excavatum  typically requires a minimally invasive surgical repair for correction.

Pectus Carinatum (Pigeon Chest)

Pectus carinatum (pigeon chest) is the second most common chest wall deformity where the breastbone and ribs are pushed outwards due to excessive growth and structural abnormalities. Patients usually experience minimal symptoms besides mild pain and tenderness, but the patient may suffer from low self-esteem and poor body image. Pectus carinatum is most often treated with orthotics and bracing at home, but advanced cases may require surgical correction.

Poland Syndrome

Poland syndrome is a rare congenital condition where affected individuals are born with undeveloped or absent pectoralis chest muscles as well as a potential absence or deformity of ribs, resulting in chest wall depression and respiratory insufficiency due to a lack of proper chest wall mechanics. The deformity is typically limited to one side of the chest. Treatments for Poland syndrome are tailored to an individual’s needs based on severity and age.

Jeune Syndrome

Jeune syndrome is the rarest of chest wall deformities. It involves congenital abnormal development of the entire chest wall, leading to a narrow, rigid chest (often described as bell-shaped) that does not allow for proper respiration mechanics, leading to respiratory insufficiency. Treatment for Jeune syndrome is focused on the support and management of respiratory functions and any resulting complications.

Treatment Procedures

Nuss Procedure

The Nuss procedure is a minimally invasive thoracoscopic repair used to correct pectus excavatum (sunken chest). Using small incisions, a metal bar is placed behind the sternum to elevate the chest wall and correct the chest wall deformity. The bar acts as an internal corrective prosthesis to reshape the chest wall over two to three years and is removed after that time. Intercostal nerve cryoablation is used to assist with postoperative pain and allows for a shorter stay in the hospital with a decreased need for narcotic pain medications. Patients typically are discharged home two to three days after the operation. Discomfort from the bar becomes minimal very quickly, and patients resume normal activity as tolerated within a few weeks, as instructed by the surgeon. The numbing effect from the cryoablation will last for two to three months, at which time the nerves recover their sensory function. Importantly, the Nuss procedure is performed after a child has completed their pubertal growth spurt to ensure that further growth will not affect the shape of the repair.

Ravitch Procedure

The Ravitch procedure is a surgical technique used to repair more severe cases of pectus excavatum (sunken chest) and pectus carinatum (pigeon chest). The Ravitch procedure involves approaching the sternum from the front, removing malformed cartilage connections to the ribs, correcting the sternal deviation and inserting a corrective bar for proper chest wall molding. This bar will be removed after approximately six months, but the time frame is dependent on the individual case. 

Benefits of Addressing Chest Wall Deformities

Chest wall deformities can impact patients physically, psychologically and socially, so exploring treatment options is important. We invite you to have a consultation with our surgeons to discover the benefits of addressing these conditions for children, including effective treatments and comprehensive care. Learn more about how we can help improve your child's overall health and quality of life.

Physical well-being

Pectus excavatum (sunken chest), pectus carinatum (pigeon chest) and other chest wall deformities can cause various physical symptoms and functional limitations. In severe cases, they can compress the heart and lungs, decreasing cardiovascular efficiency and lung capacity and resulting in shortness of breath, reduced stamina and decreased physical performance. Correcting the chest wall deformity may alleviate these physical limitations, allowing patients to breathe more easily and improve their overall physical well-being.

Psychological impact

The appearance of the chest can significantly affect an individual’s self-esteem and body image. Patients with pectus excavatum (sunken chest), pectus carinatum (pigeon chest) or other chest wall conditions may feel self-conscious about their chest deformity, leading to embarrassment, social anxiety and even depression. Restoring the chest wall can help improve body confidence and psychological well-being, allowing individuals to feel more comfortable with their bodies and engage more confidently in social interactions.

Social acceptance

Chest wall deformities can sometimes draw unwanted attention and result in social stigmatization, particularly during adolescence when body image becomes an important aspect of peer acceptance. Young patients may feel insecure about their appearance and avoid activities, such as swimming or participating in athletics and other physical activities at school, which can further affect their social interactions and overall quality of life. Correcting these chest wall deformities can help them feel more accepted and comfortable among peers, reducing social barriers and promoting a sense of belonging.

Functional improvements

Beyond the aesthetic aspects, correction of chest wall deformities can also improve functional limitations. For instance, in pectus excavatum (sunken chest) cases, corrective surgery may improve associated symptoms, exercise tolerance and overall physical function. These functional improvements can positively impact a child’s life through athletic participation, physical activities and overall physical fitness.

If your child has pectus excavatum (sunken chest), pectus carinatum (pigeon chest), Poland syndrome, Jeune syndrome or any other chest wall deformity, our pediatric surgeons will work with you and your child to create a comprehensive treatment plan specific to their unique needs.