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Pectus Excavatum

Pectus excavatum, or funnel chest (also called cobbler's chest), is caused by excessive growth of the rib cartilage next to the sternum. This excessive growth pushes the breastbone backwards. This growth occurs mainly during the growth spurt and it is during this period that we often see progression of the funnel chest.

The exact cause of this overgrowth is unknown, but sometimes it is triggered by medication, lung disease or surgery on the chest. In 25-30%, a genetic factor plays a role and it occurs in several people in the family. It can occur in isolation, but in rare cases it can also occur in combination with, for example, scoliosis, heart defects and a number of syndromes or connective tissue diseases (Marfan's disease).

One of the main reasons for treating a funnel chest is the cosmetic aspect and the possible psychosocial impact during puberty and development. There may be embarrassment about the abnormal chest and sometimes teasing from peers. A funnel chest rarely leads to physical complaints, but there may be pain, shortness of breath, fatigue and reduced stamina.

When you visit a doctor, he or she will first ask you some questions to find out more about your chest defect. For example:

  • What kind of complaints do you have?
  • Do you ever get bullied?
  • Does the disorder run in the family?

Then the doctor will want to look at and examine your chest. Depending on the shape of your chest, your build, and based on information about chest abnormalities or other conditions in your family, the doctor may decide to order additional tests, such as an ultrasound scan of the heart, a CT or an MRI scan. It may also be necessary to consult a cardiologist, orthopaedic surgeon or clinical geneticist.

The correction of a funnel chest is done through an operation in which a curved flat metal plate is placed in your chest. This plate pushes the breastbone back to its normal position (Nuss operation). In some cases where an operation is not useful or impossible, the doctor may suggest another treatment whereby you regularly 'suck' your breast forward at home with a large suction cup (vacuum bell). This vacuum treatment takes longer and the actual long-term effect is still being studied. Which treatment you qualify for depends on a number of factors, including the severity and stiffness of your funnel breast and any past surgery. Your doctor will discuss with you which treatment is best for you after his examination. More information on these treatments can be found elsewhere on this site.

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