Cardiothoracic Surgery: Adult Pectus Deformities
Children are sometimes born with deformities of the chest which can cause problems
later in life. Two common problems that involve the breastbone (sternum) and adjacent
ribs are pectus excavatum, in which the sternum appears to be sunken into the chest,
and pectus carinatum, in which the sternum appears to be pushed outward. The deformities
are usually caused by problems with development of the adjacent ribs rather than
by the sternum itself. Usually children have few if any symptoms, but are very troubled
by the appearance and the opinions of their peers. Surgical correction is straightforward
and yields good results.
Patients with these deformities who reach adulthood without correction often have
pain in addition to the cosmetic concerns. Surgical correction is usually much more
involved because the chest wall is much less flexible in the adult than in the child.
Furthermore, pediatric surgeons who routinely correct these problems in children
are often reluctant to operate on adults. Pediatric anesthesiologists often will
not put adults to sleep for the procedure. Most adult chest surgeons have very little
experience with these defects and will not attempt them.
To address this problem, UF cardiothoracic and pediatric surgeons work together
to provide repairs for these defects in adults. Together they assess the magnitude
of the defect and perform the best correction. Usually the procedure cannot be done
with a small incision and a metal bar (Nuss strut) as is done in children, because
the adult chest wall is much less flexible. However, the incision is done cosmetically
and is usually barely noticeable after healing.