Correcting Chest Wall Abnormalities in Adults


Jennifer Uscher

The ideal time for surgery for pectus excavatum—PE—is just after the growth spurts of adolescence, but few teens undergo the procedure.

“Pediatricians rarely recommended it because they saw it as a cosmetic issue and weren’t aware of the physical and psychological impacts,” says Lyall A. Gorenstein, MD, director of minimally invasive thoracic surgery and assistant professor of surgery at CUMC.

Someone born with PE has a distinct dent in the chest, caused by abnormal growth of cartilage that connects the ribs to the sternum. Those with moderate to severe PE often have reduced lung capacity and experience fatigue, shortness of breath, and chest pain when they exercise.

The indentation typically becomes more pronounced during adolescence, leading kids to withdraw from physical activities due to worsening symptoms and to feel self-conscious about the appearance of their “sunken” chest.

Surgery can be performed after adolescence, and surgeons at Columbia are treating increasing numbers of adults.

Most adults with moderate to severe PE are candidates for the minimally invasive Nuss procedure. The procedure was originally developed for correcting PE in teens, but five years ago Dr. Gorenstein began offering it to adults.

Although the procedure is less invasive than open surgery, the initial postoperative period is somewhat more painful. During the procedure, surgeons make small incisions on each side of the chest and insert one or two preformed metal bars under the sternum to force it forward. Most patients are fully recovered and off pain medications in about six weeks. Many surgeons, including those at Columbia, have moved to using two bars, especially in the more severe deformities and in older teenagers and adults, and this seems to reduce the postoperative pain and improve the results. The bars remain in place for two to four years until the chest has completely healed.

 Some older patients and those with complex chest wall deformities may require an open surgical repair called the modified Ravitch procedure. After making an incision across the front of the chest, the surgeon removes pieces of deformed chest cartilage, divides the sternum, and elevates it into the correct location. One or more metal bars are then inserted under the sternum to help maintain its new position. The bars remain permanently in place.

Dr. Gorenstein treats adults and older teens with PE, while Columbia pediatric surgeons treat younger teens. The long-term outcomes are excellent, Dr. Gorenstein says. “Patients find that their exercise tolerance and the cosmetic appearance of the chest improve. For those who undergo the Nuss procedure, there’s often further improvement in lung capacity once the bars are moved a few years later. Their lives are transformed.”

To learn more call 212-305-3408 (for adults), 212-342-8586 (for children), or visit the program’s website at