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About chest wall deformities

Chest wall deformities refer to conditions where the chest wall itself is abnormally formed. Two of the most common abnormalities are pectus excavatum, where the sternum or breastbone is depressed inward and pectus carinatum, where the front of the chest goes outward. These abnormalities are quite common, and they’re frequently noticed by the patient or family themselves.  The patients will often be completely asymptomatic, but may have intermittent episodes of chest pain, shortness of breath with exertion and exercise intolerance.  Less commonly, asymmetrical or combined type abnormalities may also occur, as well as flaring of the costal margin and isolated rib abnormalities.

Our approach to treatment

Cohen Children’s has a dedicated program to treat a wide array of chest wall deformities. The assessment begins with a thorough history and detailed physical exam. Important factors that are taken into consideration are the type of condition, the age of the patient, whether or not symptoms are present and the degree to which the condition is progressing.  Further testing is performed if necessary.  We then discuss our findings with the patient and their family to determine the best approach to treatment together.

Treatment is not always necessary, and the condition is frequently just observed. Protrusional abnormalities (such as carinatum) can frequently be treated with a custom fitted external compression brace, and dramatic improvement is seen in a period of a few short months.  If surgery is necessary, rest assured that our pediatric surgeons are trailblazers and experts in this area.  In fact, the first minimally invasive procedure for pectus excavatum (known as the Nuss procedure) ever done in New York was performed at our hospital in 2000.  Since then, we have developed our program and have become one of the busiest centers for these conditions in the New York region.

If a patient’s chest wall abnormality is associated with other medical conditions (such as structural heart disease or Marfan syndrome), we collaborate with other pediatric specialists—such as cardiologists, pulmonologists and geneticists—in order to provide comprehensive care.

We constantly reevaluate old practices and establish new protocols to provide the very best care for our patients. In fact, we have recently instituted an enhanced recovery program to optimize the recovery process after surgery. We work closely with our colleagues in pediatric anesthesia, child life and nursing to plan the pathway that the patient will take through the entire process, from well before the day of surgery to after the patient is discharged from the hospital. Our goal is to establish safe, innovative ways to minimize the effects of the surgery on the patient.

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