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.