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Pectus excavatum is a congenital deformity that causes the breastbone to appear sunken or depressed into the chest cavity. Most cases do not pose serious health risks, but patients often choose to undergo pectus excavatum repair surgery to improve their physical appearances. Pectus excavatum repair surgery is only physically necessary if the depression is deep enough to affect heart or lung functioning. The procedure involves forcing the breastbone into its correct alignment and reinforcing it with a metal bar or strut until the chest heals, a process that can take several months or years depending on the severity of the deformity. Pectus excavatum repair has a high success rate and most patients experience full recoveries.
Unless the chest is severely caved in, surgery is not recommended for patients under the age of six. Surgeons usually prefer to wait until patients are in their teenage years before considering operations so their ribs, lungs, and other internal structures have time to fully develop. Parents and their teenager can elect for the surgery if the deformity causes him or her to feel self-conscious or have difficulties engaging in physical activities. Before the procedure, the surgeon reviews that patient's medical history and imaging scans to determine if it is a good option.
Pectus excavatum repair can be performed in a few different ways, but the most common procedure involves the insertion of a curved metal bar behind the breastbone to hold it in place. The pectus bar has somewhat the same function as leg or teeth braces, correcting the alignment over a period of time until the structure can maintain its position on its own.
The procedure can take between thirty minutes and three hours to perform, during which time the patient is kept under general anesthesia. The surgeon makes an incision under each arm, approximately in line with the bottom of the breastbone. Clamps are used to hold the incisions open and create enough space to insert the pectus bar. With the curved side pointing downward, the bar is put through one incision, guided behind the breastbone, and pulled through the other incision. The surgeon then carefully turns the bar over to push the bone closer to the front of the chest.
With the pectus bar in place, the surgeon can tie it to supporting ribs, clear away damaged cartilage tissue, and suture the skin incisions. A patient is usually kept in the hospital for several days following pectus excavatum repair so doctors can provide pain medications and assess the effectiveness of surgery. He or she usually needs to rest in bed for two to three weeks after leaving the hospital, and then slowly return to physical activity over the course of several months. Regular checkups are needed to make sure the bar stays in place and the breastbone is healing properly. It can usually be removed through a simple surgery after two to four years.
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