The opposite pattern, where the chest protrudes. It is assessed in a similar way.
Many children have no physical symptoms at all. Others notice reduced exercise tolerance, breathlessness on exertion, chest discomfort, or palpitations when the depression presses on the heart. Self-consciousness about appearance is common, and is a legitimate reason to seek an assessment.
A physical examination, imaging to measure how deep the depression is, and in some cases an echocardiogram and lung function testing to understand whether the heart or lungs are affected.
Mild cases are often observed, sometimes alongside posture and exercise programs. Vacuum bell therapy can help selected younger patients whose chest wall is still flexible.
The Nuss procedure is minimally invasive — a curved bar is placed behind the breastbone through small incisions at the sides of the chest, left in place for a period and then removed. The Ravitch procedure is an open alternative suited to certain anatomy.
Correction is often considered in the early-to-mid teenage years, while the chest wall still has flexibility.
After a Nuss procedure there is an inpatient stay focused on pain control, then a gradual return to activity over several weeks. Contact sports are restricted while the bar is in place.
Not every chest wall difference needs an operation. The purpose of an assessment is to work out whether surgery is appropriate at all, and if so, when.
Chest wall assessment at Surgery Group LA is provided by Dr. Philip K. Frykman, MD, FACS. See all pediatric surgery services.
Often it causes no physical problem. When the depression is deep it can affect exercise tolerance or press on the heart, which is what the assessment looks at.
Surgical correction is frequently considered in the early-to-mid teens, though assessment can happen at any age.
Yes — with the Nuss procedure the bar stays in for a period and is then removed in a second, smaller operation.
Surgery Group LA's pediatric surgery team sees patients at the Cedars-Sinai Medical Office Towers, 8635 W 3rd St, Suite 880W, Los Angeles, CA 90048, on the Cedars-Sinai campus in Beverly Grove. The office is minutes from Beverly Hills, West Hollywood, Mid-Wilshire and Hollywood, and a short drive from Santa Monica, Brentwood and Culver City. Consultations take place in the office; surgery is performed at Cedars-Sinai Medical Center. Virtual consultations are available for patients traveling from farther away.
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