Introduction to Adult Pectus Excavatum and Its Surgical Needs

Pectus excavatum is a relatively common congenital deformity where the chest wall is sunken in, creating a caved - in appearance. It occurs when several ribs and the sternum (breastbone) grow abnormally. In adults, severe cases of pectus excavatum can have significant impacts on both physical and psychological health. Physically, it can compromise lung and heart capacity. This may lead to symptoms such as fatigue, shortness of breath, chest pain, and a fast heartbeat. During exercise, those with pectus excavatum often struggle to keep up with their peers due to limited lung expansion and oxygen intake. The proximity of the sternum and the pulmonary artery may also cause a heart murmur in some cases. Psychologically, adults with pectus excavatum may experience self - consciousness, especially in situations where their chest is exposed. This can lead to social withdrawal and a negative impact on their quality of life. Surgery becomes a viable option to correct the deformity, improve physical function, and enhance psychological well - being.

Overview of Surgical Treatments for Pectus Excavatum

There are mainly two types of surgical treatments for pectus excavatum: open surgery and closed (minimally invasive) surgery. Open surgery is the more traditional approach. The surgeon makes a cut across the front part of the chest. The deformed cartilage is removed, leaving the rib lining intact to allow the cartilage to grow back correctly. A cut is then made in the breastbone, which is moved to the correct location. A metal strut may be used to hold the breastbone in place until it heals, which takes 3 to 12 months. After 6 to 12 months, the metal struts are removed through a small cut in the skin under the arm. The minimally invasive approach, such as the Nuss procedure, is also widely used. In this procedure, the surgeon makes two small incisions on each side of the chest. A small video camera called a thoracoscope is inserted through one of the incisions to view inside the chest. A curved steel bar, shaped to fit the individual, is inserted through the incisions and placed under the breastbone to lift it. The bar is left in place for at least 2 years to help the breastbone grow properly.

Top Five Departments in New York City for Adult Pectus Excavatum Surgery

NYU Langone Health

NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum. Their doctors have in - depth knowledge and experience in diagnosing and treating this condition. - **Expertise**: The team is well - versed in both the traditional and minimally invasive surgical techniques for pectus excavatum. They stay updated with the latest research and advancements in the field, ensuring that patients receive the best possible treatment. - **Patient - Centered Approach**: They focus on understanding each patient's unique needs and circumstances. This personalized approach helps in creating customized treatment plans that lead to better outcomes. Patients can easily browse their list of providers and schedule an appointment online, making the process more convenient.

Mount Sinai - New York

Mount Sinai offers comprehensive care for pectus excavatum repair. Their treatment options cover a wide range of aspects related to the condition. - **Surgical Options**: They provide both open and closed surgical methods. For open surgery, their surgeons are highly skilled in performing the complex steps involved in removing the deformed cartilage and repositioning the breastbone. In the case of the minimally invasive approach, they have the expertise to insert the steel bar accurately under the breastbone. - **Pre - and Post - operative Care**: Before the surgery, they conduct a complete medical exam and various tests, including an electrocardiogram (ECG), echocardiogram, pulmonary function tests, and CT scan or MRI of the chest. This helps in accurately assessing the patient's condition and minimizing risks. After the surgery, they offer extensive post - operative care, including pain management, monitoring for complications, and guiding patients through the recovery process.

Columbia Surgery

Columbia Surgery has a well - established guide to pectus excavatum treatment. - **Advanced Surgical Techniques**: They are experienced in performing the Nuss procedure and the modified Ravitch repair. The Nuss procedure, performed using video - assisted thoracoscopic surgery (VATS), is a minimally invasive option that has shown good results in adults. The modified Ravitch repair, which involves removing small pieces of deformed chest cartilage and repositioning the ribs and sternum, and using titanium bars for support, is also a reliable treatment method. - **Recovery and Follow - up**: They provide clear guidelines for post - operative recovery. Patients typically leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. They also emphasize the importance of avoiding vigorous exercise for the first month and contact sports for three months after surgery. Regular follow - up appointments are scheduled to monitor the patient's progress and ensure proper healing.

NewYork - Presbyterian Queens

NewYork - Presbyterian Queens has a highly sophisticated minimally invasive thoracic surgery program. - **Minimally Invasive Approach**: Their thoracic surgeons are trained in cutting - edge techniques, including the minimally invasive Nuss procedure for pectus excavatum. This approach results in less blood loss, less postoperative pain, shorter hospital stays, and a quicker recovery and return to normal activities. It is also a viable option for many elderly and very ill patients who may not be able to tolerate conventional open surgery. - **Multidisciplinary Team**: A multidisciplinary team of thoracic surgeons, medical and radiation oncologists, pulmonologists, gastroenterologists, radiologists, pathologists, neurologists, physician assistants, nurse practitioners, dedicated thoracic intensive care nurses, respiratory therapists, speech therapists, and social workers collaborate to deliver seamless, high - quality care to patients before, during, and after their hospital stay.

NYC Health + Hospitals / Metropolitan

The department of surgery at NYC Health + Hospitals / Metropolitan offers a wide range of surgical services, including those for pectus excavatum. - **Comprehensive Surgical Services**: Their department of surgery has subspecialties such as general surgery, thoracic surgery, and pediatric surgery, which are relevant to pectus excavatum treatment. They are engaged in activities to offer the latest technologies to patients, ensuring high - quality surgical care. - **Educational and Research Focus**: The department participates in student education programs and some of their attending surgeons conduct research. This means that they stay updated with new developments in medical and surgical science, which ultimately benefits the patients. They are also more likely to adopt innovative treatment methods.

Considerations When Choosing a Department for Pectus Excavatum Surgery

Expertise of the Surgeons

- **Experience**: Look for surgeons who have a significant amount of experience in performing pectus excavatum surgeries. Surgeons who have dealt with a large number of cases are more likely to handle any complications that may arise during the surgery. - **Training and Certifications**: Ensure that the surgeons are board - certified and have received proper training in the relevant surgical techniques. This gives an assurance of their professional competence.

Range of Treatment Options

- **Surgical Techniques**: A good department should offer both traditional and minimally invasive surgical options. This allows patients to choose the treatment method that is most suitable for their condition and personal preferences. - **Comprehensive Care**: In addition to the surgery itself, the department should provide comprehensive pre - and post - operative care. This includes thorough medical evaluations before the surgery, pain management during the recovery period, and long - term follow - up to monitor the patient's progress.

Patient Reviews and Reputation

- **Online Reviews**: Check online platforms for patient reviews and testimonials. Positive reviews can give you an idea about the quality of care, the friendliness of the staff, and the overall patient experience at the department. - **Reputation in the Medical Community**: A department with a good reputation in the medical community is more likely to provide high - quality care. You can ask for recommendations from other medical professionals or check for awards and recognitions received by the department.

Cost and Insurance Coverage

- **Cost Estimate**: Get a detailed cost estimate from the department, including the cost of the surgery, hospital stay, medications, and follow - up visits. This will help you plan your finances accordingly. - **Insurance Coverage**: Check with your insurance provider to see if they cover pectus excavatum surgery at the chosen department. If not, discuss with the department's financial counselors to explore other payment options.

Comparative Analysis of the Five Departments

Department	Expertise in Surgical Techniques	Patient - Centered Approach	Pre - and Post - operative Care	Cost and Insurance
NYU Langone Health	Skilled in both traditional and minimally invasive techniques. Keeps up with the latest advancements.	Highly personalized approach with easy appointment scheduling.	Good overall care, but specific details may vary depending on the case.	Details on cost and insurance can be obtained from the department's financial office.
Mount Sinai - New York	Proficient in all surgical methods for pectus excavatum.	Focuses on understanding patient needs before treatment planning.	Comprehensive pre - operative tests and extensive post - operative monitoring and support.	Will work with patients to determine insurance coverage and offer financial guidance.
Columbia Surgery	Specialized in advanced Nuss and modified Ravitch procedures.	Provides clear information to patients about the procedure and recovery.	Well - defined recovery guidelines and regular follow - up appointments.	Cost analysis and insurance coordination available for patients.
NewYork - Presbyterian Queens	Highly trained in minimally invasive techniques, beneficial for patients with limited tolerance.	Multidisciplinary team ensures a holistic approach to patient care.	Fast recovery support due to minimally invasive methods and coordinated team care.	Offers assistance in dealing with insurance claims and payment options.
NYC Health + Hospitals / Metropolitan	Comprehensive surgical subspecialties cover all aspects of pectus excavatum treatment.	Combines patient care with educational and research initiatives.	Standard pre - and post - operative care with access to latest technologies.	Has a financial counseling service to help patients with cost and insurance issues.

Conclusion

Adult pectus excavatum can have a significant impact on both physical and psychological health. The five departments in New York City - NYU Langone Health, Mount Sinai - New York, Columbia Surgery, NewYork - Presbyterian Queens, and NYC Health + Hospitals / Metropolitan - offer high - quality surgical treatments for this condition. Each department has its own unique strengths, whether it's in surgical expertise, patient - centered care, or comprehensive pre - and post - operative support. When considering surgery for pectus excavatum, it is crucial to thoroughly evaluate these departments based on the factors mentioned above, such as the expertise of the surgeons, the range of treatment options, patient reviews, and cost and insurance coverage. By making an informed decision, patients can increase their chances of a successful surgery and a smooth recovery. If you or someone you know is suffering from pectus excavatum and is considering surgery, we encourage you to further explore these departments. Contact them directly to learn more about their services, schedule consultations, and get detailed information about the treatment process. Share this article with others who may benefit from this valuable information. Together, we can help more people find the best solutions for their pectus excavatum problems.