Have you ever noticed that some people have a hollow in the middle of their chest? Maybe you or your child has this. It can be very uncomfortable and embarrassing when you put on a T-shirt, especially when you go to a swimming pool. Also, do you feel like you have more difficulty breathing and get tired faster when you run around and play? In medicine, we call this condition Pectus Excavatum . So today we will talk about it all, very simply, in a way that you can understand.
Simply put, what is Pectus Excavatum?
It's very simple. The flat bone in the middle of our chest is called the sternum. It's the strong bone in the middle of the chest that you can feel when you touch it. In a condition called Pectus Excavatum , this breastbone does not protrude outward, but instead grows abnormally into the chest. It sinks into the chest like a funnel. This is why some people call it a "funnel chest."
When the sternum sinks inward, the four or five ribs attached to it are pulled inward on both sides. This reduces the amount of space inside the chest. This can limit the space our heart and lungs have to function freely.
This is a congenital condition. That is, a person is born with this condition. However, it is not noticeable at birth. Often, this chest dimpling becomes more apparent when a child gets a little older, especially around the age of 12-14, when the body is growing rapidly.
In terms of how common it is, it affects about one to eight out of every 1,000 children. It is also more common in boys than girls.
What are the symptoms of this condition?
The symptoms of Pectus Excavatum can be divided into two categories. One is the physical discomfort, and the other is the psychological impact. Both of these can have a significant impact on a person's life.
| Characteristic type | Explanation and examples |
|---|---|
| Physical symptoms |
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| Mental symptoms |
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The most important thing is, if you're feeling this way, don't keep it to yourself. It's not your fault. There are effective treatments for this.
Why is this happening? What is the reason?
The exact cause of Pectus Excavatum in many people has not yet been found. This means that it can just happen for no reason.
However, in some cases it has been linked to other medical conditions, particularly diseases that affect the body's connective tissue. For example:
- Marfan syndrome
- Ehlers-Danlos syndrome
These are genetic diseases. So if you have this type of disease, you are at risk of developing Pectus Excavatum.
Is this something that comes from generations?
Researchers have not yet identified a specific gene that causes Pectus Excavatum. However, they suspect that it may be genetic. Between 40% and 53% of people with Pectus Excavatum have a family member (such as a father or brother) who has the condition. So if someone in your family has it, you have a higher chance of getting it too.
How does a doctor diagnose this?
It's not usually that difficult to diagnose. When you go to see a doctor, they can diagnose it with a simple physical examination . The doctor will be able to see this dimple when he or she examines your chest.
However, to know exactly how much this condition has affected your heart and lungs, the doctor will recommend several more tests.
What are those tests?
- Chest CT scan (Computed Tomography) or MRI scan (Magnetic Resonance Imaging): These scans can take three-dimensional images of the inside of the chest. This can then accurately measure how much the sternum has sunk in and how much the heart and lungs are compressed.
- Cardiopulmonary exercise testing: This involves having you run on a treadmill to see how your heart and lungs work with exercise.
- Electrocardiogram (EKG): This tests the electrical activity of the heart to see if there are any irregularities in the heartbeat.
- Echocardiogram: This is a scan of the heart. It helps to see how the heart is functioning and the condition of the valves (such as mitral valve prolapse).
- Pulmonary Function Tests (PFTs): These measure how much air your lungs can take in and out, giving an idea of how well your lungs are working.
After conducting all these tests, the doctor will decide whether you need surgery or not.
What are the treatments? Is it incurable?
It is definitely possible! There are very effective treatments for this. There are two main surgical methods used. These surgeries are used to bring the inverted sternum back to its correct position, that is, outwards.
With both of these surgeries:
- It reduces the strain on your heart and lungs, allowing them to function better.
- Restores the appearance of your chest.
If you have physical symptoms (difficulty breathing, chest pain), or if you are experiencing severe depression due to your appearance, surgery may be the best solution.
The best age to perform this surgery is considered to be between the ages of 10 and 14. This is because at that age, the bones and cartilage of the chest are still flexible. Therefore, the surgery is easy to perform and the results are very successful.
Now let's see what these two surgical procedures are.
| Surgical method | How to do it |
|---|---|
| Nuss procedure (Minimally invasive surgery) | This is the most widely used method in the world today. There is no major incision.
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| Ravitch procedure (Open surgery) | This is a traditional open surgery.
|
Your surgeon will examine you and decide which surgery is best for you.
How long does it take to recover after surgery? Is the pain severe?
This is something that many people fear. But the best news is that thanks to modern pain management techniques, post-surgery pain is much less and recovery time is much shorter.
One of the most successful methods currently used is cryoablation .
Simply put, this involves temporarily freezing the nerves that carry pain to the chest (between the ribs) before surgery. It's like numbing your gums before a tooth extraction. This means you won't feel much pain for a few days after surgery.
Because of this method:
- You won't have to stay in the hospital for 5-7 days like you used to. You can often go home the day after surgery.
- You won't have to rely on strong painkillers (opioids) for pain like you used to.
- In the past, a school-age child had to have this surgery during school holidays because it takes about a month to heal. But now they can go back to school in two to three weeks.
Therefore, there is no reason to be afraid of surgery.
Some frequently asked questions
If I don't have surgery, will this condition get worse as I get older?
Chest tightness does not get worse as we age. However, as our body's normal functioning decreases as we age, we may start to feel more symptoms (shortness of breath, fatigue) caused by the strain on our heart and lungs.
Will my life expectancy be shortened if I don't have surgery? Will there be permanent damage to my heart and lungs?
No. There is no evidence that Pectus Excavatum shortens a person's life expectancy or causes permanent damage to the heart or lungs over time. However, if left untreated, the symptoms can become increasingly difficult to live with.
Is there no way to prevent this?
Since the exact cause of this is unknown, there is no way to prevent it from occurring.
When can I return to normal activities after surgery?
You will need to rest for a while after surgery. Once the pain has subsided, you can start walking and running a little. However, your surgeon will decide when you can start lifting weights and playing sports again. Usually, a school-age child can return to school in 2-3 weeks.
The most important thing is not to get depressed about your body image. If someone tells you that it's just a cosmetic issue, don't accept it. The physical and emotional discomfort you're feeling is real. So talk to a doctor about it openly and get the help you need.
Take-Home Message
- Pectus Excavatum is a condition in which the middle bone of the chest (sternum) sinks inward. This is a congenital condition.
- This can cause physical symptoms such as shortness of breath and fatigue, as well as embarrassment and mental stress related to appearance.
- A doctor can diagnose this with a simple examination. The condition can be further confirmed with tests such as a CT or MRI scan.
- This condition can be corrected very successfully with surgery (Nuss or Ravitch procedure).
- Thanks to modern pain management techniques (such as Cryoablation), surgery is now less painful and the recovery time is much shorter.
- If you or your child has this condition, don't be afraid or embarrassed. See a qualified doctor for advice.
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