Pectus Excavatum (Cobbler's Chest) Surgery

Pectus excavatum (cobbler's chest) is a chest wall deformity characterized by an inward depression of the breastbone. In addition to cosmetic concerns, it may cause physical problems in some people, such as shortness of breath, tiring easily and a feeling of chest tightness. Pectus excavatum surgery aims to correct this deformity, offering both cosmetic and functional benefits.

Surgical Techniques for Pectus Excavatum

1. Nuss Procedure:
   • A minimally invasive technique.
   • A metal bar is placed in the chest cavity in a way that corrects the depression.
   • The bar keeps the chest wall in the correct position for about 2-3 years.
   • Generally preferred for children and young adults.
2. Ravitch Procedure:
   • A more classical surgical method.
   • The ribs and cartilage that cause the depression are removed or reshaped.
   • Used in more complex cases.
3. Hybrid Techniques:
   • May be performed as a combination of the Nuss and Ravitch methods.
   • Offers more individualized solutions.

The Surgical Process

• Preparation:
  Before surgery, the patient's general health is assessed and the anatomy of the chest is examined with imaging techniques.
• Duration of Surgery:
  Depending on the technique, the operation usually takes 1-4 hours.
• Recovery:
  • After the Nuss procedure, patients are usually discharged within a few days and can return to daily activities within 4-6 weeks.
  • Recovery after the Ravitch procedure may take somewhat longer.
  • Physical activity is increased gradually according to the doctor's recommendations.

Who Is a Suitable Candidate for Surgery?

• Patients with physical symptoms (shortness of breath, chest pain, etc.).
• People who feel distressed because of cosmetic concerns.
• People whose general health is suitable for surgery.

Risks and Complications

As with any surgical procedure, pectus excavatum surgery carries some risks:

• Infection,
• Bleeding,
• Displacement of the bar (in the Nuss procedure),
• Rarely, injury to the lungs and heart.

However, these risks are minimal when the operation is performed by an experienced surgeon.

What Is Pectus Excavatum (Cobbler's Chest)?

Pectus excavatum is a chest wall deformity caused by an inward depression of the breastbone (sternum) and the surrounding ribs. It may be noticeable from birth or become more pronounced as growth accelerates during adolescence. While it may be seen as a cosmetic issue, in some patients it can lead to significant physical problems.

Symptoms of Pectus Excavatum

• A marked inward depression in the middle of the chest.
• Shortness of breath or tiring easily during physical effort.
• Palpitations, chest pain or a feeling of tightness.
• Loss of self-confidence and psychological effects, especially in young people.
• Reduced lung capacity (in advanced cases).

Details About Pectus Excavatum Surgery

The purpose of this surgery is to correct the depression in the chest wall, improve lung and heart function and achieve a better appearance. Today, there are several different techniques for the operation:

1. Nuss Procedure (Minimally Invasive Technique):

The Nuss method is one of the most commonly preferred techniques in the treatment of pectus excavatum.
How Is It Performed?

• Small incisions are made on the chest wall during the operation.
• A specially designed curved metal bar is placed beneath the chest wall to correct the depression.
• The bar pushes the chest wall outward and restores its normal anatomical position.
• The bar usually stays in place for 2-3 years and is then removed in a second operation.

Advantages:

• It is a minimally invasive technique and does not require large incisions.
• Recovery time is shorter.
• Cosmetic results are very good.

Disadvantages:

• Pain may be felt for a few weeks after the bar is placed.
• Complications such as bar displacement may occur, although rarely.

2. Ravitch Procedure (Classical Surgical Technique):

This method is preferred in more complex and severe cases of pectus excavatum.
How Is It Performed?

• A wider incision is made over the chest.
• The cartilage structures causing the depression are removed or reshaped.
• The breastbone is brought to its natural position and, if necessary, a supportive metal plate is placed.

Advantages:

• An effective solution in severe cases.
• The structural correction is more permanent.

Disadvantages:

• Recovery takes longer because a larger incision is required.
• Surgical scars may be permanent.