Funnel chest is one of many possible varieties of chest wall deformity. Funnel chest (pectus excavatum) is an indrawing of the central part of the front of the chest, usually asymmetrical and involving the lower part of the breastbone (sternum). Pigeon chest (pectus carinatum) is a bulging forward of the bone and cartilage in the same region.
Chest wall deformities commonly also involve the ribs or spinal column, with signs of abnormal body posture.
Children and young people are usually free of symptoms, as the chest wall is elastic in the first decades of life, and as the organs develop gradually they have time to adapt. But with increasing age there is a build-up of symptoms on exertion such as a racing heartbeat (palpitations), and patients tire easily. These symptoms can be caused by narrowing of the chest cavity, which becomes more pronounced when standing upright. The heart does not have enough room to expand in order to increase its stroke volume when required, and so needs to pump faster. The expansion of the lungs can also be restricted.
Corrective surgery with elevation of the chest wall should only be carried out by hospitals with extensive experience – if possible with a number of different treatment methods – and a high volume of operations annually, with correspondingly experienced surgeons. Only then is the procedure relatively risk-free, with a high chance of a successful outcome.
Other requirements include experience with pre- and post-operative care, skilled physiotherapists and nurses, and an intensive care unit available if needed.
Bearing in mind the remote possibility of complications such as injury to the heart, especially in minimally invasive procedures, surgery should only be carried out in centres which have facilities for cardiothoracic surgery on site.
In our centre more than 500 patients are seen and 50 corrective operations on the chest wall are carried out annually.
In specialised hospitals, chest wall surgery is in general a routine low-risk procedure. In spite of the greatest care being taken, with any of the surgical techniques complications can occasionally arise which call for further treatment. In particular, these can include:
In Germany insurers will only pay for operations with a clinical indication, and not for purely cosmetic procedures. What pre-operative investigations are needed? A lung function test and an ECG exercise test. And the usual medical examination to check fitness for surgery.
A blood transfusion is seldom necessary (but this depends on the method of surgery).
This depends on the method of surgery. Usually fitness training can begin immediately, and a return to full activity is possible for children after 6-8 weeks and for adults after 12 weeks.
Usually not until after puberty and the end of bone growth. In exceptional cases during childhood (in severe cases where there is significant encroachment on the organs of the chest).
This depends on the method and the timing of the procedure relative to the end of bone growth. The recurrence rate in long-term follow-up (five years from operation) should not exceed 2%. What possible problems can be expected during and after an operation? –>
These depend on the method and on subsequent treatment (keeping to time limits, avoiding strenuous activity too early).
Using the minimal access open method of chest wall repair (MAORPE), less than 1% of patients can expect that the chest wall elevated in the operation will subsequently sink to its original depth and require a second operation.
Our advice line is available every Thursday between 12 noon and 1 p.m. (local time). We will gladly answer your questions about chest wall corrective surgery.
Telephone +49 0211 409 2505
As well as an initial examination and advice you will be offered a patient information pack and further materials.