Introduction

Pectus excavatum is a congenital deformity of the chest wall where the breastbone (sternum) appears sunken, and the chest takes on a concave shape. While some cases may be mild and cause no significant issues, severe forms can impact lung and heart function, leading to symptoms such as shortness of breath, chest pain, and fatigue. Additionally, it can have a negative psychosocial impact on patients, especially children and teenagers. For those seeking treatment, surgery is often a viable option. In New York City, several hospitals stand out for their expertise in pectus excavatum correction surgery. In this article, we will carefully examine the top five hospitals for this procedure.

Understanding Pectus Excavatum

Pectus excavatum is more common in males than females and can either be present at birth or develop during puberty. The exact cause is not fully understood, but it is believed to be related to excessive growth of the cartilage connecting the ribs to the breastbone, which pulls the sternum inward. As per Columbia Surgery, it can range from mild to severe, with severe cases having a significant impact on a person's physical well - being.

Symptoms of pectus excavatum can vary. Some patients may experience no symptoms at all, while others may have difficulty breathing, especially during exercise. Fatigue, chest pain, and a fast heartbeat can also be present. In addition, the visible deformity can cause self - consciousness, particularly in adolescents, leading to social withdrawal and a negative body image.

Diagnosis of Pectus Excavatum

Doctors use multiple tools to diagnose pectus excavatum and measure its severity. These include:

• Visual examination: A simple physical check to assess the appearance of the chest.
• Auscultation: Listening to the heart and chest sounds to detect any effects on heart and lung function.
• Electrocardiogram (ECG or EKG): Records the electrical activity of the heart.
• Echocardiogram: Uses sound waves to create a picture of the heart.
• Pulmonary function testing: Measures the amount of air a person can breathe in and out over a period of time.
• Chest X - ray: Provides a basic image of the chest structure.
• CT - scan: Gives a more detailed view of the chest, and the Haller index can be calculated from it. A Haller index greater than 3.25 is generally considered severe (a normal Haller index is 2.5).

Top Five Hospitals for Pectus Excavatum Correction Surgery in New York City

1. Columbia University's Surgical Lung & Chest Care Program

As part of Columbia University Irving Medical Center and New York - Presbyterian, this program is consistently ranked as one of New York's top hospitals and among the top ten medical centers in the nation. Their thoracic surgery team has extensive experience in treating all types of chest conditions, including pectus excavatum.

They offer two main surgical options for pectus excavatum correction:

• Nuss procedure: This minimally invasive procedure is performed using video - assisted thoracoscopic surgery (VATS). A convex bar is inserted through small incisions in the side of the chest and turned to push the sternum outward. The bar remains in place for at least three years while the chest contour re - forms. It was originally developed for children but has also been successful in adults.
• Modified Ravitch repair: Involves removing small pieces of deformed chest cartilage and repositioning the ribs and sternum. Titanium bars are used to support the repaired chest architecture and can remain permanently in place, avoiding the need for a second operation.

The program's experts include Dr. Lyall A. Gorenstein, who specializes in thoracic surgery with a focus on minimally invasive thoracic surgery, hyperhidrosis - palmar, and pectus excavatum. He is board - certified in surgery and thoracic surgery and graduated from Canada in 1983, having completed his training at several renowned institutions.

For patients, the recovery time after surgery varies. Most people leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. However, vigorous exercise should be avoided for the first month, and contact sports for three months.

2. The Center of Excellence for Pectus

Established in 2005, this center is the premier destination for the Nuss procedure to treat pectus excavatum and evaluate all forms of pectus. Dr. Barry Losasso, the director of the center, has performed over 1,400 minimally invasive Nuss procedures to correct pectus excavatum in both adolescents and adults aged 10 - 55 years old. He trained with Dr. Donald Nuss, the creator of the Nuss procedure.

The center is one of the only ones to perform chest wall reconstruction on patients in the specified age range. Dr. Losasso's experience and expertise are highly regarded in the field, and he has continued to be recognized by his peers for his contributions to improving patient care and outcomes.

The best age for the Nuss procedure at this center is between 13 – 16 years old when the chest's cartilage and bones are more malleable. However, Dr. Losasso has successfully completed procedures on patients as old as 53 years old. The center also offers excellent pain management, with a team that closely monitors patients' pain following surgery.

3. NYU Langone Health

NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum patients. Their doctors are well - trained in both surgical and non - surgical approaches to treating this condition. They take a comprehensive approach, considering the patient's overall health, age, and the severity of the pectus excavatum.

The hospital offers state - of - the - art facilities and the latest surgical techniques. They work closely with patients and their families to develop a treatment plan that meets their specific needs. Whether it's a minimally invasive procedure or a more traditional open surgery, NYU Langone's doctors have the expertise to perform the surgery safely and effectively.

Patients at NYU Langone can expect a high level of support throughout the treatment process, from the initial consultation to post - operative care. The hospital also has access to a wide range of resources, including physical therapy, psychological counseling, and support groups, to help patients and their families cope with the emotional and physical aspects of living with pectus excavatum.

4. Mount Sinai - New York

Mount Sinai offers both open and closed (minimally invasive) surgeries for pectus excavatum repair. Open surgery is more traditional and involves making a cut across the front of the chest, removing the deformed cartilage, repositioning the breastbone, and using a metal strut to hold it in place until it heals. The struts are removed in 6 to 12 months through a small cut under the arm.

The minimally invasive approach is mostly used for children. It involves making two small incisions on each side of the chest, inserting a thoracoscope to view inside the chest, and then placing a curved steel bar under the breastbone to lift it. The bar remains in place for at least 2 years to help the breastbone grow properly.

Before the surgery, patients at Mount Sinai undergo a complete medical exam and various tests, including an electrocardiogram, pulmonary function tests, and a CT scan or MRI of the chest. After the procedure, children typically stay in the hospital for 3 to 7 days, and pain management is a key part of the post - operative care. The hospital's medical team also provides detailed instructions for at - home care to ensure a smooth recovery.

5. Harlem Hospital

While not primarily known as a specialized pectus excavatum center, Harlem Hospital has a team of skilled surgeons who can perform the necessary corrective surgeries. The hospital offers a range of medical services, including internal medicine, obstetrics & gynecology, and general surgery. It also provides telehealth services, which can be convenient for patients during the pre - and post - operative stages.

Patients at Harlem Hospital have reported positive experiences with some of the doctors. For example, Dr. Barry at the hospital is highly regarded as one of the best surgeons not only in the US but also in the world. He performed a Nuss surgery on a patient with a complicated pectus excavatum case three years ago, and the patient's chest now looks wonderful. Dr. Barry also recently removed the bars in an easy and smooth surgery.

The hospital's staff is committed to providing patient - centered care, listening to patients' concerns, and answering their questions. They also strive to ensure that the surgical procedures are performed with the highest level of safety and quality.

Comparison of the Top Five Hospitals

Factors to Consider When Choosing a Hospital

When selecting a hospital for pectus excavatum correction surgery, several factors should be taken into account:

• Expertise of the medical team: Look for hospitals with surgeons who have extensive experience in performing pectus excavatum surgeries. Check their qualifications, training, and the number of procedures they have completed successfully.
• Surgical techniques: Consider the available surgical options and whether they are appropriate for your condition. Minimally invasive procedures may offer shorter recovery times and less scarring, but traditional open surgeries may be necessary in some cases.
• Patient reviews and testimonials: Read about the experiences of other patients who have undergone surgery at the hospital. This can give you an idea of the quality of care, the surgical outcomes, and the level of patient satisfaction.
• Support services: A hospital that offers comprehensive support services, such as physical therapy, psychological counseling, and support groups, can greatly enhance your recovery process and overall well - being.
• Location and convenience: Consider the hospital's location and whether it is easily accessible for you and your family. Also, check if the hospital offers telehealth services, which can be useful for pre - and post - operative consultations.

Pre - operative and Post - operative Care

Pre - operative Care

Regardless of the hospital you choose, pre - operative care is crucial for a successful surgery. As mentioned in the information about Mount Sinai - New York, a complete medical exam and various tests are usually required. These tests help the doctors assess your overall health, the condition of your heart and lungs, and the severity of the pectus excavatum. You should also inform the medical team about any medications you are taking, including over - the - counter drugs, herbs, and supplements, as well as any allergies you may have.

In the days leading up to the surgery, you may be asked to stop taking certain medications, such as blood - thinning drugs. On the day of the surgery, you will likely be instructed not to eat or drink anything after midnight the night before. It is important to follow all these instructions carefully to reduce the risks associated with the surgery.

Post - operative Care

After the surgery, patients will need to stay in the hospital for a few days for monitoring. Pain management is a key aspect of post - operative care. Patients may receive strong pain medicine in the vein or through a catheter placed in the spine for the first few days, and then switch to oral medications. Chest tubes may be placed to drain extra fluid around the surgical site, and they will be removed once the drainage stops.

Patients are encouraged to start moving around as soon as possible after the surgery, such as sitting up, taking deep breaths, and walking. This helps with the healing process. However, certain activities, such as bending, twisting, or rolling from side to side, should be avoided initially. The return to normal activities, including work or school, will depend on the individual's recovery progress.

Conclusion

Selecting the right hospital for pectus excavatum correction surgery is a crucial decision that can have a significant impact on the outcome of the procedure and the patient's overall well - being. In New York City, hospitals like Columbia University's Surgical Lung & Chest Care Program, The Center of Excellence for Pectus, NYU Langone Health, Mount Sinai - New York, and Harlem Hospital offer high - quality care and expertise in treating this condition. Each hospital has its own strengths, whether it's specialized surgical techniques, experienced medical teams, or comprehensive support services.

When making a decision, patients and their families should carefully consider the factors mentioned above, such as the expertise of the medical team, the available surgical options, patient reviews, and support services. By doing so, they can choose the hospital that best meets their needs and gives them the best chance of a successful recovery.

If you or someone you know is considering pectus excavatum correction surgery, we encourage you to do further research, schedule consultations with doctors at these hospitals, and discuss your concerns and expectations. This will help you make an informed decision and take the first step towards improving your health and quality of life.