Chest wall reconstruction in Kansas City
When your child or teenager has a condition involving the chest wall, you need the most advanced and compassionate care possible. At HCA Midwest Health, our seasoned, patient-focused specialists in Kansas City offer some of the most progressive surgical and non-surgical treatments for chest wall conditions, such as pectus excavatum and pectus carinatum.
For more information about chest wall disorder treatments, call our pediatrics team at (913) 541-5437 (KIDS).
Pediatric chest wall condition care
Overland Park Regional Medical Center offers comprehensive pediatric care, including pediatric surgery. Our pediatric chest wall specialists understand that with no known cause for chest wall conditions and symptoms ranging from mild to severe, chest wall abnormalities require special care. Given the complexities of chest wall conditions, our multi-disciplinary team includes experts specializing in pediatric cardiology and pulmonary care.
What are chest wall disorders?
Chest wall disorders are often congenital conditions that are more common in men than women. Chest wall conditions develop when the cartilage connecting the ribs grows evenly. This can create a sunken or protruding appearance. The exact causes of chest wall abnormalities are unknown.
Chest wall disorders are usually noticeable in children at 1-2 years old. The condition may be mild at first and become more severe during puberty when the bones and cartilage grow rapidly.
Children with chest wall conditions may not have symptoms other than feeling self-conscious about their appearance. However, chest wall disorders can cause heart and lung issues, such as asthma.
Chest wall conditions we treat
Some of the chest wall conditions we treat include:
- Pectus carinatum (a congenital chest wall condition, also called pigeon chest, in which the breastbone and ribs protrude)
- Pectus excavatum (a common congenital chest wall condition, also called sunken chest, in which the breastbone dips inward)
- Poland syndrome (a congenital chest wall condition where muscle only develops on one side of the body, causing an asymmetrical appearance)
- Slipping rib syndrome (a condition often caused by injury or trauma in which the cartilage on the lower rib moves, causing pain in the upper chest and abdomen)
Chest wall disorder treatments
Our pediatric chest wall specialists take the time to talk to children and their families to ensure they understand their treatment options. We generally do not operate on children with chest wall conditions who are 6 years old or younger. However, we evaluate children at every age and develop individualized treatment plans for them.
We use a variety of surgical and non-surgical methods to treat chest wall conditions, including:
- Modified Ravitch technique (surgical removal of the cartilage causing the defect)
- Nuss procedure (inserting bars behind the sternum to push it into a normal position)
- Vacuum bell (using suction, or a vacuum, to pull the chest and breastbone into a normal position)
An external brace can be used to treat pectus carinatum without surgery. The brace gently pushes the chest into normal position over time. In most cases, pectus carinatum can be corrected entirely with bracing in 3-6 months.
With this treatment, a unique brace is made for each patient. An orthotist makes recommendations on how often the brace must be worn. With follow-up visits, the brace may be adjusted to contour to the child's chest as they grow and their condition improves.
Modified Ravitch technique
The modified Ravitch procedure is a surgical technique used to treat pectus carinatum, pectus excavatum and Poland syndrome, usually in young adults. It involves making an incision across the chest and removing the cartilage causing the defect. The sternum is then placed in the standard position. In procedures used to treat pectus excavatum, a small bar is inserted under the sternum to hold it in place.
Surgery for pectus carinatum creates scar tissue around the ribs. This can affect how the ribs grow. Therefore, surgery is usually delayed until the child completes their growth phase.
Our pediatric surgeons are experts at performing the Nuss procedure, which is the most common surgical treatment for pectus excavatum. This minimally invasive technique involves inserting a metal support bar underneath the sternum to reverse the depression in the chest. The bar inserted during the procedure is typically left in place for two to three years.
We strive to make patients as comfortable as possible following surgery. That's why, after we perform the Nuss procedure, we use nerve cryoablation to "freeze" the nerves and manage pain.
Nuss procedure for adult chest wall disorders
For optimal results, the Nuss procedure is often performed on patients during adolescence. However, it can be performed on adults. In 2017, the Director of Pediatric and Fetal Surgery at Overland Park Regional Medical Center, Corey Iqbal, MD, opened the first program in the Kansas City region that performed the Nuss procedure on adults. Before that, this life-changing treatment was only available to patients who traveled out of state to one of the three hospitals that offered it.
The vacuum bell is a non-surgical treatment for mild to moderate pectus excavatum. A vacuum bell is carefully fitted to sit comfortably on the patient’s chest. A bulb attached to the device generates negative pressure to create a vacuum, which raises the sternum over time by slowly pulling up the depressed area of cartilage.
It may take several months of use to reach the maximum correction and require up to two years of regular use to ensure sustained correction. The vacuum bell is an innovation that provides an effective treatment for patients without the time loss of surgery. Children can use the bell at a time of their choosing. The bell is worn several hours each day for six to 12 months.
Chest wall disorder treatment in Lee's Summit
In addition to the chest wall disorder treatment services available at Overland Park Regional Medical Center, we offer pediatric care at Lee's Summit Medical Center. This hospital is currently expanding its pediatric subspecialty services. HCA Midwest Health hospitals work together to coordinate care and streamline the healthcare process as much as possible for our patients.
Frequently asked questions
We know that you have questions about your child's care. With this in mind, we have answered some of the questions we are frequently asked to help you better understand your child's diagnosis and treatment.
At what age is the Nuss procedure most commonly performed?
For optimal results, the Nuss repair typically takes place during early adolescence but can be performed with excellent results even in adulthood. We look at each patient individually to determine a treatment plan that best suits his or her needs.
Do you ever perform pectus corrective surgery on children younger than 6 years old?
We generally do not operate on children 6 years old and younger with pectus excavatum. However, we will evaluate children with all chest wall problems at any age and develop a plan for them on an individual basis.
Is my 19 year old too old to have pectus corrective surgery?
No, your child is not too old to have pectus corrective surgery. We performed our first pectus corrective surgery on an adult in 2017.
Is pectus correction ever an emergency?
No. If you child's symptoms are worsening, then you should begin the steps to have them evaluated and plan for surgery immediately, but correcting the chest abnormality is never considered an emergency. This is a procedure that must be planned. Take your time. Prepare your family and your child for the procedure.
Will my child be able to participate in sports after the Nuss procedure?
We encourage our patients to maintain active and healthy lifestyles before and after surgery. Three months after surgery, patients can return to competitive sports: however, contact sports like football, boxing and wrestling, are discouraged.
How is pectus carinatum treated?
Fortunately, most people with pectus carinatum can avoid surgery by using an external brace that gently pushes the chest in over time. In fact, 95 percent of people with pectus carinatum will have complete correction of their chest within three to six months of using a brace.
What happens after treatment for pectus carinatum?
After having a brace made, your orthotist will make recommendations on how often to wear the brace. They will be available for follow-up visits to make any adjustments to the brace, which may be needed as the contour of a child’s chest changes with treatment and growth.
What complications can occur after treatment of pectus carinatum?
The most common complication after treating pectus carinatum is having the carinatum come back. This can happen with bracing or with the surgery. If the carinatum recurs, going back to the brace will oftentimes correct it. Bracing can even be tried after surgery, but it is less common to have a recurrence after surgery.
Use of the brace can lead to skin irritation and in rare cases a pressure ulcer. For these reasons, it is recommended that if there’s any signs of skin irritation or discomfort to follow up with your orthotist to make appropriate adjustments.
What are the long-term effects of having pectus carinatum treated?
There are no long-term effects from wearing a brace to treat pectus carinatum. Surgery for pectus carinatum creates scar tissue around the ribs, which can affect how the ribs grow. Therefore, if surgery is being considered, it is usually delayed until the child is through their growth phase.