How is Pectus Treated?
Pectus excavatum can be treated safely in a variety of ways. There are two main categories of pectus excavatum treatments: surgical and non-surgical.
Non-surgical treatments are most often used for younger patients or in mild cases of pectus excavatum. Surgical treatments are used in severe cases of pectus, when the pectus isn't responsive to non-surgical treatment options, or when the pectus is impacting the internal organs. There are two types of non-surgical treatments: physical therapy and vacuum bell therapy. The two surgical procedures used to correct pectus are the Nuss and Ravitch procedures. Other techniques have been used or are being developed to correct pectus, like the Magnetic Mini-Mover Procedure, but these are the safest and most commonly used options.
Surgical Options:
Nuss Procedure
Minimally invasive, typically done for ages 10-19
The Nuss Procedure is a minimally-invasive procedure created in 1997 that uses a concave metal bar to surgically correct severe pectus excavatum. The bar is inverted to push the sternum out, and remains in place typically for three years. It is normally used on children aged 10 to 19. [1] It's considered a "minimally invasive" procedure because typically only three small incisions are needed [2]. Read more
Ravitch Procedure
Invasive, typically done for ages 13-22
The Ravitch Procedure is an invasive surgery that was created over 60 years ago to treat pectus excavatum [3]. During the procedure, a large incision is made in the chest and bars are put in place to help reshape the sternum, cartilage is removed, and ribs are attached to the sternum [5]. If used, the Ravitch is most often preformed for older individuals (when the bones are more calcified), when the pectus is asymmetrical, or when the deformity isn't responsive to the less invasive Nuss procedure [4]. Read more
Non-Surgical Options:
Vaccum Bell
What the Nuss bar looks like in the chest
What the Nuss bar looks like
Vaccum bells come in a variety of sizes.
Used in mild cases of pectus or in young patients, when the chest wall is still malleable
Vacuum bell therapy is a technique, first developed in 2005, used to treat pectus excavatum non-surgically. The vacuum bell is a cup-shaped device made of soft rubber that’s connected to a hand pump. The suction created by the vacuum bell pulls the breastbone outward [6]. Read more
Physical Therapy
Used to address the symptoms side of pectus
Physical therapy is primarily used to address the symptoms side of pectus excavatum. It can be a valuable tool to minimize pain for those with pectus excavatum and help improve athletic performance. Physical therapy is also used after corrective surgeries like the Nuss and Ravitch procedures to bring the body back to its normal strength [7]. Read more
References
1. Nuss Procedure. (n.d.). Children's Hospital of Philadelphia.
https://www.chop.edu/treatments/
nuss-procedure#:~:text=The%20Nuss%20procedure%20is%20a,until%20the%20age%20of%201
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2. Casas-Melley, A. (n.d.). Pectus excavatum: The Nuss Procedure. Kids Health.
Retrieved November 6, 2023, from https://kidshealth.org/en/parents/nuss-procedure.html
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3. Blanco, F. C., Elliott, S. T., & Sandler, A. D. (2011). Management of congenital chest wall deformities.
Seminars in plastic surgery, 25(1), 107–116. https://doi.org/10.1055/s-0031-1275177
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4. Casas-Melley, A. T., M.D (Ed.). (n.d.). The Ravitch Procedure. Nemours
KidsHealth. https://kidshealth.org/en/parents/ravitch-procedure.html
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5. Pectus excavatum treatments. (n.d.). Stanford Medicine.
https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/
pectus-excavatum/treatments.html
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6. Anzilotti, A. W., M.D. (Ed.). (n.d.). Pectus excavatum: Vacuum bell device.
Nemours KidsHealth. https://kidshealth.org/en/parents/vacuum-bell-device.html
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7. Lyon, K. (2023, October 7). [Personal interview by the author].
Dr. Katy Lyon, PT, DPT, is a physical therapist at Back in Motion Physical
Therapy, in Lorton, Virginia.
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