Understanding Mild Pectus Excavatum
Pectus excavatum is a congenital deformity where the breastbone (sternum) and ribs grow abnormally, causing a sunken or caved - in appearance of the chest. It occurs in approximately 1 in 400 births and is more common in boys than girls. In mild cases, the symptoms may not be as severe as in extreme ones, but it can still have an impact on the patient's self - esteem and, in some cases, respiratory or cardiac function.
Symptoms of Mild Pectus Excavatum
- Visual Appearance: The most obvious symptom is the sunken appearance of the chest. In mild cases, this may be a slight depression that might not be immediately noticeable, especially when the patient is clothed.
- Breathing Difficulties: While not as severe as in severe pectus excavatum, some patients with mild cases may experience mild shortness of breath during physical exertion, like running or climbing stairs. However, these symptoms are often subtle and may be attributed to other factors by the patient or overlooked.
- Chest Pain: Occasional chest pain can occur, especially after long - periods of physical activity or certain postures. This pain is usually not severe but can be a discomfort for the patient.
- Psychological Impact: Even a mild depression in the chest can cause self - consciousness, especially in adolescents and young adults. It may lead to avoidance of activities that expose the chest, such as swimming or going to the beach.
Diagnosis of Mild Pectus Excavatum
Doctors use several methods to diagnose mild pectus excavatum:
Physical Examination
A simple visual inspection of the chest can often identify the sunken appearance. The doctor may also palpate the chest to feel the shape and position of the sternum and ribs.
Imaging Tests
- Chest X - ray: This can provide a basic view of the chest structure and help the doctor see the overall shape of the sternum and ribs.
- CT Scan: A more detailed imaging test, a CT scan can accurately measure the depth and extent of the chest depression. The Haller index, calculated from the CT scan, is used to quantify the severity of pectus excavatum. A Haller index greater than 3.25 is generally considered severe, while mild cases may have a lower value.
- Echocardiogram: This test uses sound waves to create an image of the heart. It can help determine if the pectus excavatum is having any impact on the heart's function or position.
- Pulmonary Function Tests: These tests measure how well the lungs are working. Although mild pectus excavatum may not significantly affect lung function, these tests can detect any subtle changes.
Hospitals in New York City for Mild Pectus Excavatum Correction
NYU Langone Health
NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum. Their experts have extensive experience in treating various levels of the condition, including mild cases. They offer a comprehensive approach that includes both non - surgical and surgical treatment options. Patients can browse their list of providers who treat pectus excavatum and schedule an appointment online.
Mount Sinai - New York
Mount Sinai offers surgical repair for pectus excavatum. They have detailed protocols for both open and closed (minimally invasive) surgeries. For mild pectus excavatum, minimally invasive options may be more suitable. The closed method, often used for children, involves making two small incisions on each side of the chest, inserting a curved steel bar under the breastbone to lift it, and leaving the bar in place for at least 2 years to help the breastbone grow properly. Mount Sinai also provides pre - and post - operative care and education to ensure a smooth recovery process.
NewYork - Presbyterian / Columbia University Irving Medical Center
Dr. Lyall A. Gorenstein, affiliated with this hospital, specializes in thoracic surgery, with a special focus on minimally invasive thoracic surgery and pectus excavatum. Their team uses the latest techniques and technologies for the diagnosis and treatment of pectus excavatum. They offer both the Nuss procedure and the modified Ravitch repair. The Nuss procedure, a minimally invasive surgery, is often a good option for mild cases, as it involves small incisions and has a relatively quick recovery time.
Treatment Options for Mild Pectus Excavatum
Non - Surgical Treatments
- Physical Therapy: Specific chest - specific physical therapy exercises can help strengthen the chest muscles. This can improve the appearance of the chest by building up the surrounding muscles and may also alleviate some of the minor symptoms like chest pain. Physical therapists can design customized exercise programs based on the patient's condition and fitness level.
- Bracing: In some cases, a custom - made brace can be used to apply gentle pressure on the chest to gradually correct the shape. Bracing is usually more effective in younger patients whose bones are still growing. It needs to be worn for a certain number of hours each day, and regular follow - up appointments are required to monitor the progress.
- Vacuum Bell Therapy: This involves using a device that creates a vacuum on the chest, which helps to lift the sunken sternum. It is a non - invasive option that can be used at home under the guidance of a medical professional. Some patients have reported improvements in the appearance of their chest after consistent use of the vacuum bell.
Surgical Treatments
- Nuss Procedure: This is a minimally invasive surgery where two small incisions are made on each side of the chest. A curved steel bar is inserted under the breastbone and turned to lift the sternum into a more normal position. The bar is left in place for 2 - 3 years to allow the chest to remodel. It is often preferred for mild cases due to its less invasive nature, smaller incisions, and shorter recovery time compared to traditional open surgeries.
- Modified Ravitch Repair: This procedure involves making a horizontal incision, removing small pieces of deformed chest cartilage, and repositioning the protruding ribs and sternum. Titanium bars are used to support the repaired chest architecture. In some cases, the bars can remain permanently in place, eliminating the need for a second operation to remove them.
Price List for Pectus Excavatum Correction
The cost of pectus excavatum correction can vary depending on several factors, including the type of treatment, the severity of the condition, the length of the hospital stay, and the hospital or doctor's fees. Here is a general price list based on available information:
Non - Surgical Treatments
| Treatment | Cost Range |
|---|---|
| Physical Therapy (per session) | $50 - $200 |
| Bracing (custom - made) | $1,000 - $5,000 |
| Vacuum Bell Therapy (device) | $500 - $2,000 |
Surgical Treatments
| Procedure | Cost Range |
|---|---|
| Nuss Procedure | $40,000 - $65,000 |
| Modified Ravitch Repair | $50,000 - $80,000 |
It's important to note that these are approximate costs, and insurance coverage can significantly reduce the out - of - pocket expenses for the patient. Most insurance plans in the United States cover pectus excavatum surgery if it is deemed medically necessary, but the specific coverage details vary by insurance provider.
Pre - operative and Post - operative Care
Pre - operative Care
Before undergoing any treatment for pectus excavatum, patients will need to undergo a series of pre - operative steps:
- Medical Exams and Tests: A complete medical exam, electrocardiogram (ECG), echocardiogram, pulmonary function tests, and CT scan or MRI of the chest may be required. These tests help the doctor assess the patient's overall health and the severity of the pectus excavatum.
- Medication Review: Patients should inform the doctor about all the medications they are taking, including over - the - counter drugs, herbs, and supplements. Some medications, such as blood - thinners, may need to be stopped a few days before the surgery to reduce the risk of bleeding.
- Dietary Restrictions: Patients may be asked not to eat or drink anything after midnight the night before the surgery. They should follow any specific dietary instructions provided by the doctor.
Post - operative Care
After the treatment, proper post - operative care is crucial for a successful recovery:
- Hospital Stay: For surgical procedures, the hospital stay can range from 3 to 7 days, depending on the type of surgery and the patient's recovery progress. During this time, the patient will be closely monitored for any complications, and pain management will be provided.
- Pain Management: Patients may receive strong pain medicine in the vein (through an IV) or through a catheter placed in the spine (an epidural) in the first few days after surgery. After that, pain is usually managed with oral medications.
- Activity Restrictions: Patients will need to avoid heavy physical exertion, bending, twisting, or rolling from side to side for a certain period. They may also need to avoid contact sports for several months. Gradually, they can increase their activity level as they recover.
- Follow - up Appointments: Regular follow - up appointments with the doctor are necessary to monitor the healing process, remove any surgical devices (such as bars), and ensure that the chest is returning to a normal shape.
Conclusion
Mild pectus excavatum can have both physical and psychological impacts on patients. Fortunately, there are several treatment options available in New York City, including non - surgical and surgical approaches. Hospitals like NYU Langone Health, Mount Sinai - New York, and NewYork - Presbyterian / Columbia University Irving Medical Center offer high - quality care for patients with this condition. The cost of treatment can vary, and insurance coverage may be available. Proper pre - operative and post - operative care is essential for a successful recovery.
If you or someone you know is dealing with mild pectus excavatum, don't hesitate to reach out to a medical professional. Schedule a consultation with one of the hospitals mentioned above to discuss the best treatment options for your specific situation. Share this article with others who may benefit from this information, and stay informed about the latest developments in pectus excavatum treatment.
