Introduction
Funnel chest, also known as pectus excavatum, is a congenital deformity that causes the ribs and breastbone to grow inward, giving the chest wall a sunken appearance. This condition can have both physical and psychological impacts on patients. In Albany, finding the right hospital for funnel chest correction surgery is crucial for achieving the best possible outcomes. This guide aims to provide comprehensive information about funnel chest, available surgical options, and plastic surgery hospitals in Albany that offer these procedures.
Understanding Funnel Chest
Definition and Prevalence
Funnel chest occurs when there is an abnormal growth of cartilage within the chest wall, pushing the sternum and ribs inward. It is the most frequent congenital anomaly of the chest wall, occurring in about 1 in 400 births and is more commonly found in boys than girls. In children aged 7 - 14, it affects approximately 2.6 percent. The condition often doesn't fully manifest until adolescence during rapid bone growth.
Causes and Associated Conditions
The exact cause of funnel chest is not known, but there is sometimes a tendency for it to run in families. It may also be associated with other skeletal conditions, such as scoliosis. In addition, some patients with pectus deformities may have inherited connective tissue disorders like Marfan syndrome, homocystinuria, or Ehlers - Danlos syndrome. When a child is diagnosed with funnel chest, doctors often ask about the history of murmurs, scoliosis, and episodes of the heart racing unexpectedly, as funnel chest is associated with mitral valve prolapse (which can be recognized by a heart murmur), Wolff - Parkinson - White (an abnormal pathway in the atrium of the heart causing arrhythmia), and connective tissue disorders.
Symptoms
Funnel chest can cause a variety of symptoms. Physically, children may experience shortness of breath, exercise intolerance, palpitations, and chest or back pain. These symptoms occur because the deformity can affect the function of the heart and lungs by displacing them and putting pressure on the chest cavity. Psychologically, as the child reaches pre - teen or adolescent years, the sunken appearance of the chest can make them self - conscious and cause anxiety.
Diagnosis of Funnel Chest
Due to the visible nature of funnel chest, it can usually be initially diagnosed by a physical examination of the chest wall. However, to determine the severity of the condition and its impact on the heart and lungs, a series of tests may be required. These tests include:
- CT Chest Scan: This scan helps evaluate the internal chest anatomy and structure. It also allows physicians to calculate the Haller index, which is an indicator of the severity of the pectus excavatum deformity.
- Echocardiogram: An ultrasound of the heart to evaluate its structure and function.
- Pulmonary Function Tests (PFTs): These tests assess lung function.
- Metal Allergy Testing: Since some treatments involve the placement of bars, patients may need to be tested for metal allergies, especially to nickel. If a patient is allergic to nickel, a special type of bar will be required.
Treatment Options for Funnel Chest
Non - Surgical Options
For mild cases of funnel chest, non - surgical options may be considered. These include monitoring the patient's growth and performing chest - specific physical therapy. Physical therapy can help strengthen the chest muscles, improve posture, and may have a positive impact on the appearance of the chest. In some younger patients, a chest brace may also be used to try to correct the deformity as the child grows.
Surgical Options
Moderate and severe cases of funnel chest often require surgical correction. The two most commonly used surgical procedures are:
The Ravitch Procedure
In the Ravitch procedure, the surgeon makes an incision along the chest wall over the sternum. A modified approach involves making incisions as small as possible. The surgeon then removes the abnormal cartilage around the area of deformity, detaches the sternum, and repositions it. Sometimes, a small metal bar is placed under the sternum to support it in the desired position. The bar is usually left in place for about one to two years until the cartilage can solidify in the new corrected position. The operation to remove the bar is typically performed on an outpatient basis. This procedure is especially well - suited for patients who do not wish to have a bar in place for more than one year, those with highly asymmetric chest wall deformities, or problematic lower rib flaring.
The Minimally Invasive Nuss Procedure
The Nuss procedure is a minimally invasive approach. The surgeon makes a small incision on either side of the chest and then custom - fits a curved steel or titanium bar for the patient’s chest wall. The bar is introduced through the incisions and tunneled under the sternum. It is then rotated into place, which elevates the sternum and corrects the defect. On occasion, two bars are required to fully correct the pectus deformity. During the procedure, a small camera (thoracoscope) is used to monitor bar placement and decrease the risk of injury to surrounding structures. The bar usually stays in place for two to three years, and the operation to remove it is also performed on an outpatient basis. This procedure results in less obvious scarring due to the smaller incisions and offers a faster recovery time compared to traditional open surgeries.
Plastic Surgery Techniques for Funnel Chest
Plastic surgeons play an important role in funnel chest correction, especially when it comes to achieving better aesthetic results. Some plastic surgery techniques used for funnel chest include:
Silastic Implants
Custom - made silicone elastomer prostheses can be deeply placed behind the muscle and aponeuroses. This simple and non - invasive technique is often chosen when the deformation is mainly morphological or aesthetic. The implants have some advantages, such as being a minimally invasive, low - priced, and brief intervention with a fairly predictable result. However, there can be disadvantages, including late material abrasion, late seroma formation, potential tight calcification, and pain. In the past, this technique was banned in the United States, but modern customized implants have improved in terms of material composition and tissue compatibility.
Cartilage Chips Transfer
Autologous cartilage can be used to correct minor deformities. This method is well - suited for the pectus arcuatum deformity, a rare entity with a depression and protrusion of individual ribs. The prerequisite for this technique is the presence of rib humps with abundant cartilage as a donor site. Resected rib portions are processed into small chips, wrapped in a highly flexible absorbable mesh, and embedded in a subcutaneous presternal or epicostal submuscular pocket. The rate of resorption is low, and once incorporated, the result can last for life.
Lipofilling
Autologous transfer of fat tissue is a promising technique for filling in a funnel depression without major surgical trauma or scars. However, the heterogeneous behavior of transplanted fat cells and the fact that many funnel chest patients, especially young and slim ones, may have a lack of transferable fat limit its applicability. It is usually reserved for adults with good nutritional status.
Choosing a Hospital in Albany for Funnel Chest Correction Surgery
Importance of Selecting the Right Hospital
Selecting the right hospital for funnel chest correction surgery is crucial. A well - equipped hospital with experienced surgeons, anesthesiologists, and nursing staff can ensure better surgical outcomes, minimize complications, and provide comprehensive post - operative care. Additionally, the hospital's expertise in handling specific surgical techniques and the availability of support services can greatly impact the patient's recovery process.
Plastic Surgery Group in Albany
The Plastic Surgery Group in Albany, NY, is a notable option for funnel chest correction surgery. The group has a team of experienced plastic surgeons and dedicated support staff who strive to provide beautiful, natural - looking results and a rewarding patient experience.
Surgeons at the Plastic Surgery Group
- Susan M. Gannon, MD: Dr. Gannon has impressive qualifications and a compassionate personality. She earned her medical degree from Albany Medical College and completed her residency in plastic and reconstructive surgery at Albany Medical Center Hospital. She furthered her education at the Manhattan Eye, Ear, and Throat Institute at Lennox Hill Hospital. Dr. Gannon performs both plastic and reconstructive surgical procedures for the face, breasts, body, and hands and aims to impart confidence in her patients through natural - looking results. She is certified by the American Board of Plastic Surgery and has numerous professional affiliations and honors.
- Craig Fournier, MD: Dr. Fournier brings a personalized touch and top - tier aesthetic fellowship training to patient care. He completed his medical school education at Tufts University School of Medicine and a plastic and reconstructive surgery residency at Albany Medical Center. He then had an aesthetic plastic surgery fellowship year at Manhattan Eye Ear and Throat Hospital. Dr. Fournier performs aesthetic and reconstructive surgery on the breast and body, with specialized expertise in face and nose surgery. He is board - eligible with the American Board of Plastic Surgery and has a strong presence in the plastic surgery community through his publications and presentations.
- Briana Benson, PA: As a physician assistant, Briana Benson evaluates pre and post - operative patients, assists in the operating room, and performs many minimally invasive procedures. She began her career in orthopedics and then transitioned to plastic and reconstructive surgery at Albany Medical Center, where she spent seven years refining her skills. She is certified by the National Commission on Certification of Physician Assistants and has several professional affiliations.
Services Offered
The Plastic Surgery Group offers a wide range of procedures, including those relevant to funnel chest correction. In addition to surgical procedures, they have a medical spa, Spa One, where aesthetic professionals offer innovative and customized treatments. They also provide a free initial consultation to help patients understand their options and make informed decisions.
Preparing for Funnel Chest Correction Surgery
Before Surgery
If you decide to have surgery, there are several steps you can take to prepare:
- Strengthen Chest Muscles: Exercises that strengthen the chest muscles before surgery can help increase strength and make the muscles more balanced. This will also help the chest wall adjust more easily after surgery.
- Understand the Procedure: Have in - depth discussions with your surgeon about the surgical procedure, including what to expect during and after the surgery, potential risks, and recovery time.
- Follow Pre - operative Instructions: Your surgeon will provide you with specific pre - operative instructions, such as fasting before the surgery, avoiding certain medications, and arranging for someone to accompany you to and from the hospital.
After Surgery
Hospital Stay
For both the Ravitch and Nuss procedures, the average hospital stay is four to seven days. During this time, the medical team will closely monitor your condition, manage pain, and provide wound care.
Pain Management
The surgeries are performed under general anesthesia. Before surgery, an anesthesiologist may insert an epidural catheter into the back while the patient is asleep to allow for pain medication administration after surgery. Patients may receive a combination of intravenous (IV) and oral pain medications, such as through an epidural or a patient - controlled analgesia (PCA) pump. Once the patient is ready, the IV pain medications are stopped, and they are transitioned to a combination of oral pain medications. Most children will require two to three weeks of oral pain medications after discharge from the hospital.
Wound Care
It is crucial to take good care of the surgical site until it is fully healed. Your doctor will provide detailed instructions on how to clean and care for the wound, and you may need to keep the area dry and clean to prevent infection.
Activity Level
Patients are generally advised to abstain from heavy physical exertion for about 6 weeks. This includes no backpacks on the shoulder for three months to avoid stressing the area. They can return to very light aerobic activity, such as walking and breathing exercises, six weeks after surgery. After six weeks, they can begin stronger cardiovascular conditioning, and after the initial six - week recovery period, they can slowly start engaging in more intense sports. However, precautions should be taken to avoid a forcible blow to the chest to prevent the bar from shifting.
Post - operative Follow - up
Routine post - surgical follow - up with your pediatric surgeon and team is important and should be done at regular intervals for up to two years post - surgery. The exact interval timing should be checked with your surgeon. Between appointments, seek medical attention if you experience symptoms such as chest pain, shortness of breath, persistent cough, fevers greater than 101.5°F, pain unrelieved by oral medications, constipation, or other concerns.
Conclusion
Funnel chest is a congenital condition that can have physical and psychological impacts on patients. With the advancement of surgical techniques, including plastic surgery options, there are effective ways to correct this deformity. In Albany, hospitals like the Plastic Surgery Group offer comprehensive care for funnel chest correction surgery, with experienced surgeons and a range of services. When considering funnel chest correction surgery, it is essential to thoroughly research your options, understand the procedures, and prepare well for the surgery and recovery process.
If you or someone you know is affected by funnel chest, take the first step towards correction by scheduling a consultation with a qualified plastic surgeon in Albany. Share this article with others who may benefit from this information and explore related topics to gain a deeper understanding of funnel chest and its treatment.
