Pectus excavatum – funnel chest

What is pectus excavatum?

The pectus excavatum, sunken chest, or funnel chest is one of the most common disorders in the development and growth of costal cartilage. This problem consists of a sinking of the sternum that causes an alteration of the rib joints, which are deformed, projecting them, sometimes, forward.

Pectus excavatum is a condition whose cause is unknown; however, sometimes this disorder may be associated with other deformities such as osteogenesis imperfecta, rickets, scoliosis, Poland syndrome and others such as Marfan, Ehlers-Danlos, Noonan or Turner syndrome.

Which are the signs and symtoms of pectus excavatum?

Although this congenital (from birth) disorder may not be noticeable during the first years of life or, even until the adolescence stage, the pectus excavatum makes the chest look somewhat sunken. According to Chiu PH, in A cross-sectional study of lung volume development in pectus excavatum patients this malformation can be classified according to its severity as:

• Type 1: severe but symmetrical deformities, located in the sternum.
• Type 2: shallower but more diffuse and wider deformations.
• Type 3: severe cases with asymmetric deformation of the thoracic cavity.

On the other hand, in addition to the aesthetic effects on the patient, it must be taken into account that  in severe cases, extra pressure is exerted on the lung and heart. This could lead not only to problems in exercising or physical activity, but more worryingly in respiratory complications, constant tiredness and fatigue, chest pain, palpitations and frequent bronchopulmonary infections. However, functional impairment by a pectus excavatum is extremely rare.

Which is the treatment for pectus excavatum?

To date, thoracic surgery has been the only effective treatment to correct this defect. For the treatment of the pectus excavatum there are several types of surgical procedures such as the Nuss, Ravitch technique, or the Taulinoplasty. At Antiaging Group Barcelona we have a definitive and safe method to solve this congenital problem of the rib cage,  by the Anatomik Modeling company.

This company has created a custom implant based on chest deformity using a CT scan. The implant covers and models the entire defect and is implanted in depth, following Professor Chavoin’s technique, partially covered by the pectoralis major musculature. The advantages of this surgical technique are:

• Personalization based on the existing congenital deformity.
• Use of a soft but solid silicone material, with a touch similar to that of the sternum and definitive. The edges of the implant adapt to the defect and are also covered by the muscles.
• To improve the results, lipofilling (fat grafts) can usually be associated in a second time, since it is easier to see the possible small residual defects.

How is the procedure with custom-made implants?

Silicone implants are designed virtually after performing a CT scan of the patient and using a computer-assisted process, in which the thoracic cavity is rebuilt. These implants offer a minimally invasive, safe and simple solution to the pectus excavatum, avoiding open chest surgeries and their possible complications.

The surgical procedure is carried out under general anesthesia and lasts about 60 minutes, in which the surgeon makes an incision in the chest cavity from which the implant slides. Then hospitalization is one night. Subsequently, physical exercise should be avoided for 8-12 weeks depending on the size of the implant.

The reference centers in Anatomik Modeling, such as Antiaging Group Barcelona, ​​have received theoretical and practical training on the computer construction of 3D implants and the different intervention techniques (pectus excavatum, Poland Syndrome or other deformities due to lack of muscles).