The Ranking of Experts for Pectus Excavatum Correction Among 20 - Year - Olds in New York City and the Plastic Surgery Comparison Atlas!

Introduction

Pectus excavatum, often referred to as “sunken chest syndrome,” is a relatively common congenital chest deformity that can have a significant impact on both the physical and psychological well - being of those affected. For 20 - year - olds in New York City, the decision to seek correction for pectus excavatum involves choosing the right expert and understanding the available plastic surgery options. In this article, we will explore the experts in this field, compare different plastic surgery techniques, and provide comprehensive information for individuals considering pectus excavatum correction.

Understanding Pectus Excavatum

Definition and Prevalence

Pectus excavatum is a condition where the breastbone (sternum) and ribs grow abnormally, causing a sunken or concave appearance in the chest. It affects approximately 1 in 300 to 1 in 500 people, with males being affected three to four times more often than females (UCLA Health). The deformity may be present at birth or develop during puberty, and in many cases, it tends to worsen over time.

Causes and Risk Factors

The exact cause of pectus excavatum is not fully understood. However, it is believed to be related to an overgrowth of the rib cartilages that connect the ribs to the breastbone. This abnormal growth pulls the sternum inward, creating the characteristic sunken chest. A family history of the condition is also a significant risk factor, as about 40% of people with pectus excavatum have one or more family members with the defect (Columbia Surgery).

Symptoms and Complications

In mild cases, pectus excavatum may not cause any symptoms. However, as the condition progresses, especially in severe cases, it can lead to various physical and psychological problems. Physically, it can affect lung and heart capacity, resulting in symptoms such as fatigue, shortness of breath, chest pain, and a fast heartbeat. Some individuals may also develop a heart murmur due to the proximity of the sternum and the pulmonary artery.
Psychologically, pectus excavatum can have a negative impact on self - esteem, especially during adolescence and young adulthood. People with this condition may feel self - conscious about their appearance, which can lead to social withdrawal and avoidance of activities that expose the chest, such as swimming or sports.

Diagnosis of Pectus Excavatum

Physical Examination

A doctor can often diagnose pectus excavatum through a simple physical examination of the chest. They will look for the characteristic sunken appearance and may also assess the severity of the deformity by observing the patient's posture and any associated physical symptoms.

Diagnostic Tests

• Chest X - ray: This test can visualize the dip in the breastbone and often shows the heart being displaced into the left side of the chest. It is a quick and painless way to get a basic understanding of the condition (Mayo Clinic).
• CT Scan or MRI: These tests provide more detailed images of the chest. CT scans and MRIs can help determine the severity of the pectus excavatum and whether the heart or lungs are being compressed. They take many images from a variety of angles to produce cross - sectional images of the body's internal structure (Mayo Clinic).
• Electrocardiogram (ECG): An ECG can show whether the heart's rhythm is normal or irregular and if the electrical signals that control the heartbeat are timed properly. It involves the placement of more than a dozen electrical leads on the body with a sticky adhesive (Mayo Clinic).
• Echocardiogram: This is a sonogram of the heart that can show real - time images of how well the heart and its valves are working. It also gives the doctor a look at how the chest wall may be affecting heart function and the flow of blood through the heart (Mayo Clinic).
• Lung Function Tests: These tests measure the amount of air the lungs can hold and how quickly the lungs can empty. They help assess the impact of pectus excavatum on lung function (Mayo Clinic).
• Exercise Function Test: This test monitors how well the heart and lungs function while the patient exercises, usually on a bike or treadmill. It can help determine the functional limitations caused by pectus excavatum (Mayo Clinic).
• Haller Index: Calculated from a CT scan, the Haller index measures the extent of pectus excavatum. It is the ratio of the horizontal distance of the inside of the rib cage to the shortest distance between the vertebrae and sternum. A Haller index greater than 3.25 is generally considered severe, while a normal index is around 2.5 (Columbia Surgery).

Plastic Surgery Options for Pectus Excavatum Correction

Nuss Procedure

The Nuss procedure is a minimally invasive surgical technique for correcting pectus excavatum. It was first introduced in 1997 and has since become a popular choice for both children and adults. In this procedure, a curved metal bar is inserted through small incisions on each side of the chest and placed under the depressed breastbone. The bar is then flipped over to create an arch that presses upward on the breastbone, raising it into a more normal position. In some cases, more than one bar may be used.
After the bars are in place, they are left for two to three years to allow the chest wall to re - form. Once the chest has adapted to the new shape, the bars are removed as an outpatient procedure. One of the advantages of the Nuss procedure is that it results in smaller scars compared to open surgical methods. Additionally, patients generally experience a shorter hospital stay and quicker recovery time.
However, the Nuss procedure also has some potential complications. There is a risk of bar displacement, which may require surgical repositioning. In a study of 1215 patients who underwent the Nuss procedure, the bar displacement rate requiring surgical repositioning decreased from 12% in the first decade to 1% in the second decade (PubMed). Other potential complications include wound infection, hemothorax, and pain, although techniques such as cryoablation have been used to minimize pain after surgery.

Ravitch Technique

The Ravitch technique is an older, more traditional open surgical procedure for pectus excavatum correction. It involves making a large incision down the center of the chest. The surgeon then removes the deformed cartilage attaching the ribs to the lower breastbone and fixes the breastbone into a more normal position using surgical hardware, such as a metal strut or mesh supports.
One of the benefits of the Ravitch technique is that it allows for more direct access to the deformed structures, which may be necessary in cases of severe or complex pectus excavatum. However, it also has some drawbacks. The large incision results in a more significant scar, and the recovery time is generally longer compared to the Nuss procedure. Additionally, there is a higher risk of complications such as infection and bleeding due to the more invasive nature of the surgery.
In recent years, a modified Ravitch repair has been developed. In this modified version, titanium bars are secured to the ribs and sternum to support the repaired chest architecture. Unlike in the past, the current bars can remain permanently in place, eliminating the need for a second operation to remove the supports.

Experts for Pectus Excavatum Correction in New York City

UCLA Health

UCLA Health has a long - standing pectus program with a history of innovation. Their program began in the 1960s with Eric Fon Kalsrud, MD, an international authority on the management of chest wall deformities and a pioneer of pectus surgery. The pediatric general surgeons at UCLA Health, such as Justin Wagner, MD, and Veronica “Ronnie” Sullins, MD, have extensive experience in diagnosing and treating pectus excavatum in both children and adults.
UCLA Health uses the Nuss procedure for pectus excavatum correction, along with techniques like intercostal nerve cryoablation to minimize pain after surgery. Many patients at UCLA Health have reported significant improvements in their breathing, stamina, and appearance after surgery. For example, Adele Noyer, a 13 - year - old who underwent surgery at UCLA Mattel Children's Hospital, was able to return to her regular physical activities and had improved confidence in her appearance after the procedure (UCLA Health).

Mount Sinai - New York

Mount Sinai offers both open and closed (minimally invasive) surgeries for pectus excavatum repair. Their surgical team is experienced in performing procedures on children and adults in their early 20s. The hospital provides comprehensive pre - and post - operative care, including detailed medical evaluations, pain management, and rehabilitation guidance.
Before surgery, patients at Mount Sinai undergo a complete medical exam and various tests, such as an electrocardiogram, pulmonary function tests, and a CT scan or MRI of the chest. After surgery, the hospital's team closely monitors patients' recovery, and pain is managed with a combination of medications.

Columbia Surgery

Columbia Surgery has a dedicated team for the treatment of pectus excavatum. They offer both the Nuss procedure and the modified Ravitch repair. The ideal age for surgical treatment at Columbia Surgery is between 12 and 18 years, but they also have experience treating adult patients.
Their surgeons focus on improving breathing, posture, and cardiac function, in addition to giving the chest a normal appearance. After surgery, most patients leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. The hospital also provides detailed post - operative instructions to ensure a smooth recovery, such as avoiding vigorous exercise for the first month and contact sports for three months after surgery.

Cleveland Clinic Children's

Cleveland Clinic Children's is a nationally renowned resource for the management of pediatric chest wall deformities, including pectus excavatum. Over 98% of their pectus excavatum patients have been successfully treated with the minimally invasive Nuss procedure.
The pediatric surgeons at Cleveland Clinic Children's are leaders in operative and non - operative corrective chest wall procedures. They use an innovative technique called cryoablation to manage pain during the Nuss procedure, which also shortens the hospital stays and reduces the need for opioids. Adult patients are cared for by the heart and vascular institute's department of thoracic and cardiovascular surgery at the Cleveland Clinic.

Johns Hopkins Children's Center

Johns Hopkins Children's Center has a highly experienced pediatric surgical team specializing in the treatment of chest wall deformities. The center was once the home of Mark Ravitch, who perfected the original open repair of pectus excavatum, and Alex Haller, who introduced the radiographically defined pectus excavatum severity score (Haller index).
Paul Colombani at Johns Hopkins modified the minimally invasive Nuss procedure, allowing for improved safety during the procedure and greater stability of the bar. The modified Nuss procedure at Johns Hopkins has led to decreased complications and excellent clinical results. The center's team provides comprehensive care for young children and adolescents suffering from pectus excavatum, from diagnosis to post - operative recovery.

Recovery and Aftercare

Hospital Stay

The length of hospital stay after pectus excavatum surgery varies depending on the procedure and the individual patient. For the Nuss procedure, patients typically stay in the hospital for 2 to 3 days, while those undergoing the Ravitch technique may require a longer stay, usually 3 to 7 days (Mount Sinai). During this time, patients are closely monitored for pain management, wound healing, and any signs of complications.

Pain Management

Pain is a common concern after pectus excavatum surgery. For the first few days, patients may receive strong pain medicine through an intravenous line or an epidural catheter. After that, pain is usually managed with oral medications. Cryoablation, a technique that temporarily freezes the nerves to block pain, has been shown to be effective in reducing postoperative pain for 4 to 6 weeks (Mayo Clinic). Parents of patients, like Linda Noyer, have reported that their children could manage pain with non - opioid medications after a few days following the use of cryoablation (UCLA Health).

Activity Restrictions

After surgery, patients are advised to limit their physical activity to allow for proper healing. In the initial days and weeks, patients may not be able to bend, twist, or roll from side to side. Heavy lifting, lying on either side or the stomach, and wearing backpacks should be avoided as they can cause the bar (in the case of the Nuss procedure) to slip.
As the recovery progresses, activities can be gradually increased. However, patients are generally advised to avoid vigorous exercise for the first month after surgery and contact sports for three months after surgery. Once the bars are removed (in the Nuss procedure), patients can typically resume normal physical activities.

Follow - up Care

Regular follow - up appointments are essential after pectus excavatum surgery. These appointments allow the surgeon to monitor the patient's recovery, check for any signs of complications, and ensure that the chest is healing properly. The bars used in the Nuss procedure are usually removed after two to three years, and the patient will need to return to the hospital for this outpatient procedure. The surgeon may also order follow - up tests, such as chest X - rays or lung function tests, to assess the long - term results of the surgery.

Conclusion

For 20 - year - olds in New York City with pectus excavatum, there are several excellent experts and plastic surgery options available for correction. The Nuss procedure and the Ravitch technique each have their own advantages and disadvantages, and the choice of procedure depends on factors such as the severity of the deformity, the patient's overall health, and personal preferences.
By understanding the diagnosis process, the surgical options, and the recovery and aftercare requirements, individuals can make informed decisions about their treatment. The experts in New York City, such as those at UCLA Health, Mount Sinai, Columbia Surgery, Cleveland Clinic Children's, and Johns Hopkins Children's Center, have the experience and expertise to provide high - quality care for pectus excavatum correction.

Call - to - Action

If you or someone you know is considering pectus excavatum correction, we encourage you to reach out to the experts in New York City. You can schedule a consultation with the surgical teams at the hospitals mentioned in this article to learn more about the available treatment options and to determine the best course of action for your specific situation. Share this article with others who may benefit from this information and continue to explore related topics on pectus excavatum treatment and recovery.