Pectus Chest Wall Program
The surgeons of Austin Pediatric Surgery have helped to establish a multidisciplinary pectus excavatum and carinatum program at Dell Children’s Medical Center. We continue to use our evidence-based outcomes and collaborate between the patient and family, surgeons, anesthesiologists, physical and occupational therapists, and nursing staff to strive for the best care of patients with chest wall deformities. We also collaborate with pulmonary and cardiology during pre-op evaluations.
There are two main types of chest wall abnormalities – pectus excavatum, where the chest has a caved-in appearance, and pectus carinatum, where the chest protrudes outward. Some patients have a combination of pectus excavatum and carinatum, and treatment options may be surgical or non-surgical. Our team will work with you and your family to make the best plan for your condition.
Pectus excavatum, or “funnel chest” occurs in 1 in 300-400 people. It is more common in males than females. It is usually sporadic but may run in families. There is an increased prevalence of pectus excavatum in patients who have connective tissue disorders, suggesting that it is caused by abnormal development of the cartilage bridging the sternum and the ribs. The condition may be present when the child is young, and most commonly becomes more prominent during the rapid growth of the pre-teen and teen years.
Many patients with pectus excavatum are asymptomatic. But many others complain of shortness of breath, especially while exercising, or an inability to keep up physically with their peers. They may feel embarrassed or ashamed of their physical appearance, and this impaired body image can result in lower self-esteem and impaired quality of life.
Pectus excavatum often requires an operation to elevate the sternum, potentially improving heart and lung function, as well as improving the appearance of the chest. The procedure is generally done via a minimally invasive approach, where two small incisions are made under the armpits and a curved metal bar is placed under the ribs and sternum. The bar is generally left in place for two to three years.
At Austin Pediatric Surgery, we have taken the model of Enhanced Recovery After Surgery (ERAS) techniques that have improved surgical outcomes in other procedures and developed a pectus pathway to improve postoperative pain control, encourage early mobility, and decrease hospital length of stay. This pathway optimizes care before, during, and after your surgery. Advancement in surgical techniques and pain control at our institution have decreased the amount of time patients stay in the hospital after surgery and have improved comfort, even with less need for pain medications after discharge.
All families will start with a consultation with a pediatric surgeon. If the decision for surgery is made, we employ a joint evaluation with pain control specialists and physical therapists around the time of the operation. We have a dedicated physical therapy program that begins before the procedure and continues after surgery. Patients are generally out of bed the day of surgery and most can be comfortably discharged in the first few days after the operation.
Pectus carinatum, or “pigeon chest” is a less common variant of a pectus anomaly. As with excavatum, the condition generally becomes noticeable and more prominent during the pre-teen to teenage years. Most patients with pectus carinatum are candidates for bracing to correct the defect, though occasionally surgery is indicated. We will help you to determine and carry out the right plan for your condition.
Erich J. Grethel, MD, FACS, FAAP
Dr. Erich Grethel is a board certified pediatric surgeon who has a special interest in pectus deformities and leads the Pectus Chest Wall Program at APS. Dr. Grethel lives in Austin, Texas with his wife and three children. He has been practicing pediatric surgery here since 2010. He is surgeon champion for the Dell pediatric NSQIP team and is involved in quality and outcome measures for pediatric surgery patients.
Please call our office at 512-708-1234 for an appointment or email firstname.lastname@example.org with any questions.