Introduction to Pectus Excavatum
Pectus excavatum, commonly known as “sunken chest syndrome,” is a congenital condition where the breastbone is sunken into the chest. It occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved - in or sunken appearance. This condition is more common in boys than girls, and it often doesn't fully manifest until adolescence during rapid bone growth. It can range from a narrow cup shape to a wider bowl or plate shape. Up to 20 percent of patients may have other skeletal conditions, such as scoliosis. According to Lurie Children's, pectus excavatum occurs in 1 in 400 births and is found in 2.6 percent of children aged 7 – 14.
Symptoms and Effects
Funnel chest may cause children to sometimes feel shortness of breath, experience exercise intolerance, or have palpitations, which can interfere with heart and lung function. As the child reaches the pre - teen or adolescent years, the caved - in or hollow appearance may make them self - conscious and can cause anxiety. For example, Adele Noyer in the UCLA Health case had a hard time keeping up with friends on the playground by third grade and her stamina markedly decreased by seventh grade as a swimmer on the school team. Adult patients like Leigh Dannhauser also experienced a significant decrease in physical endurance, with difficulties in activities like crossfit workouts, bike rides, and walking, along with heart palpitations.
Diagnosis
Because of the visual nature of this condition, pectus excavatum can usually be initially diagnosed by physical examination of the chest wall. Depending on the symptoms and clinical findings, the medical team may request a series of tests including echocardiogram, pulmonary function test, or CT scan. A quantitative determination is also made by measuring the space between the front of the chest and the spine in the most sunken portion and comparing that to the width of the chest at its widest.
Top Three Hospitals for Adolescent Pectus Excavatum Correction in New York City
ColumbiaDoctors Children's Health
Multidisciplinary Approach
Columbia's multidisciplinary medical team is a key strength. They evaluate, monitor, and treat children and adolescents with a range of chest wall anomalies, from pectus excavatum and carinatum to rare, life - threatening conditions. Their pediatric surgeons collaborate with doctors from other pediatric specialties, including orthopedic surgery, plastic surgery, cardiology, pulmonology, genetics, and radiology, as well as nurse practitioners, orthotists, and physical therapists. This comprehensive approach ensures that all aspects of a patient's condition are considered during treatment.
Treatment Methods
They have extensive experience in using a minimally invasive approach to treat pectus excavatum and in addressing pectus carinatum with bracing rather than surgery. With specialists from orthopedic surgery and pulmonology, they also care for children with severe, complex abnormalities affecting both the chest wall and spine. This shows their ability to provide a variety of treatment options based on the individual needs of the patient.
Mount Sinai - New York
Surgical Expertise
Mount Sinai offers two types of surgery to repair pectus excavatum: open surgery and closed (minimally invasive) surgery. Open surgery involves making a cut across the front part of the chest, removing deformed cartilage, repositioning the breastbone, and using a metal strut to hold it in place until it heals. The closed method, mainly used for children, involves making two small incisions, inserting a curved steel bar under the breastbone, and leaving it in place for at least 2 years to help the breastbone grow properly.
Pre - and Post - operative Care
Before the procedure, a complete medical exam and various medical tests are conducted, including an electrocardiogram, pulmonary function tests, and CT scan or MRI of the chest. The hospital also provides detailed instructions for pre - operative preparations, such as stopping certain medications and fasting before surgery. After the procedure, patients usually stay in the hospital for 3 to 7 days, and pain management is carefully planned. Tubes may be placed in the chest to drain extra fluid, and patients are encouraged to engage in activities like sitting up, taking deep breaths, and walking the day after surgery to aid in healing.
The Center of Excellence for Pectus
Specialized in Nuss Procedure
The Center of Excellence for Pectus is the premier center for the nuss procedure to treat pectus excavatum. Dr. Barry Losasso, who has performed over 1,400 minimally invasive nuss procedures, trained with Dr. Donald Nuss, the founder of the nuss procedure. The best age to get the nuss procedure is between 13 – 16 years old when the chest’s cartilage and bones are still malleable, but Dr. Losasso has successfully completed many nuss procedures in patients as old as 53 years old.
Comprehensive Patient Care
The center provides comprehensive care, from the initial consultation to post - operative follow - up. They order imaging to measure the Haller index to determine the severity of the pectus deformity. They also have an excellent pain management team at Valley Hospital to monitor pain closely following the surgery, ensuring a successful and uneventful recovery for patients.
Treatment Options for Pectus Excavatum
Non - Surgical Treatments
For mild cases, non - surgical treatments may be considered. Physical therapy can help strengthen the chest muscles and improve posture. Bracing can also be used for some patients, especially those with pectus carinatum. However, the effectiveness of these non - surgical methods may vary depending on the severity of the condition.
Surgical Treatments
Ravitch Procedure
The Ravitch procedure is an open surgery. The surgeon makes an incision to remove abnormal cartilage and place the sternum in the appropriate position. A steel bar may be inserted to support and elevate this area as it heals, and the bar is removed approximately one year later as an outpatient procedure. This procedure is especially well - suited for patients who do not wish to have a bar in place for more than one year and those with highly asymmetric chest wall deformities or problematic lower rib flaring.
Nuss Procedure
The Nuss procedure is a minimally invasive surgery. Incision sites are made on both sides of the chest wall, and corrective, custom - fitted steel bar(s) are inserted under the sternum and secured in place. Typically, these bar(s) remain in place for two to three years. Due to the smaller incisions, the Nuss procedure results in less obvious scarring.
| Treatment Type | Advantages | Disadvantages | Recovery Time |
|---|---|---|---|
| Physical Therapy | Non - invasive, can improve muscle strength and posture | May not be effective for severe cases, slow results | Long - term, continuous treatment |
| Bracing | Non - surgical, can be used for some mild cases | Requires long - term wear, may be uncomfortable | Months to years |
| Ravitch Procedure | Good for specific chest wall deformities, bar removal after one year | Open surgery, more invasive, larger scar | About 6 weeks of limited activity, full recovery 3 - 12 months |
| Nuss Procedure | Minimally invasive, less obvious scarring | Bar remains in place for 2 - 3 years | About 6 weeks of limited activity, gradual return to normal activities |
Importance of Adolescent Treatment
Adolescence is an ideal time to evaluate and treat pectus excavatum. During this period, the chest wall is changing quickly, and the cartilage and bones are still malleable. This makes it easier to correct the deformity through surgical or non - surgical means. Treating the condition during adolescence can also have a significant impact on the patient's psychological well - being. Many adolescents with pectus excavatum feel self - conscious about their appearance, which can lead to anxiety and social withdrawal. By correcting the deformity, they can gain more confidence and have a better quality of life. For example, Adele Noyer's mother mentioned that the surgery not only improved her breathing and stamina but also was great for her confidence as a middle schooler, as she no longer had to worry about how she looked when wearing swimsuits or tank tops.
Success Stories and Patient Experiences
Adele Noyer's Case at UCLA Health
Adele Noyer's parents noticed the indentation in her chest when she was a baby. By third grade, she was having difficulty keeping up with friends on the playground, and her condition worsened over the years. In early March 2025, after a growth spurt tapered off, she underwent surgery at the UCLA Mattel Children's Hospital. A titanium bar was inserted across her chest under her sternum through two small incisions. After the surgery, she gradually recovered. She was back in school after a week and was able to return to all her regular physical activities by her birthday in June. The surgery was a great success, improving both her physical condition and her confidence.
Leigh Dannhauser's Case at UCLA Health
Leigh Dannhauser, a 32 - year - old UCLA law student, had a two - inch divot in her chest for years. However, in 2021, her physical endurance decreased significantly, and she experienced heart palpitations. Imaging showed that her sternum was compressing her heart and shoving it over into her lung. She underwent the Nuss procedure in late July 2022. After the surgery, the heart palpitations disappeared, and she gradually recovered. By the end of the year, she felt more normal, and by the summer after graduating, she was back in crossfit and even climbed Mt. Fuji.
Considerations for Choosing a Hospital
Medical Expertise
When choosing a hospital for adolescent pectus excavatum correction, the medical expertise of the hospital's staff is crucial. Look for hospitals with experienced pediatric surgeons who are familiar with the latest treatment methods, such as the Nuss procedure and the Ravitch procedure. Check if the surgeons have trained with well - known experts in the field. For example, Dr. Barry Losasso at The Center of Excellence for Pectus trained with Dr. Donald Nuss, the creator of the Nuss procedure.
Multidisciplinary Team
A hospital with a multidisciplinary team is an advantage. Pectus excavatum can have an impact on various aspects of a patient's health, including the heart, lungs, and musculoskeletal system. A team that includes pediatric surgeons, cardiologists, pulmonologists, physical therapists, and other specialists can provide comprehensive care and address all the patient's needs. ColumbiaDoctors Children's Health is an example of a hospital with a multidisciplinary team.
Patient Care and Support
Good patient care and support are essential for a successful recovery. This includes pre - operative counseling, pain management during and after surgery, and post - operative follow - up. Hospitals should have a clear plan for pain management, as surgeries for pectus excavatum can be painful. They should also provide detailed instructions for post - operative care, such as activity restrictions and wound care. Mount Sinai - New York offers comprehensive pre - and post - operative care, including specific instructions for patients and their families.
Conclusion
Pectus excavatum is a congenital condition that can have significant physical and psychological impacts on adolescents. Fortunately, there are effective treatment options available, including non - surgical and surgical methods. In New York City, ColumbiaDoctors Children's Health, Mount Sinai - New York, and The Center of Excellence for Pectus stand out as top hospitals for adolescent pectus excavatum correction. These hospitals offer specialized expertise, multidisciplinary care, and excellent patient support. If your child or an adolescent you know is suffering from pectus excavatum, don't hesitate to seek professional medical advice. Consider reaching out to one of these top hospitals to explore the best treatment options. Share this article with others who may be interested in learning more about pectus excavatum and the available treatment resources.
