What to Expect & FAQs: Pectus Excavatum (in adults)
Prior to Surgery
- Talk to your doctor about any medications/vitamins/herbs you are taking. You may need to stop certain ones before surgery.
- Discuss any possible bleeding disorders or other medical conditions that you may have.
- You will receive a call from the hospital the afternoon (or early evening) of the day prior to surgery to inform you what time to arrive and where to go.
- Do not eat or drink anything after midnight the night before the surgery. Rare exceptions to this, such as medicines for high blood pressure or epilepsy, should be discussed with your surgeon.
Day of the Surgery
- Take any medications that the doctor has approved with a small sip of water.
- You may have blood samples taken, to check blood count and blood type. Women of childbearing age will usually be asked to do a urine pregnancy test.
- You will be asked to change into a surgical gown and an intravenous (IV) will be started in the preop area.
After Surgery
You may be in the hospital for three to five days following surgery. Some patients are discharged sooner, and others may need to stay longer. During the hospital stay, you will:
- Receive several different medicines to relieve pain, including long-acting local anesthetics, long-acting oral pain medications, non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, IV pain medications, and multi-level intercostal nerve blocks.
- Begin eating ice chips or sipping clear liquids immediately after the operation. Solid foods will be added gradually (to decrease the chance of nausea or vomiting). Once your appetite returns, you can usually return to a normal diet.
- Have X-rays taken to ensure that any hardware (bar or bars) is in place and that the lungs are fully expanded.
- Sit up in bed once you feel strong enough to do so.
- Have a bladder catheter until two days after surgery. This will be placed by the operating room nurse after general anesthesia begins.
- Walk with the assistance of a physical therapist or nurse who will teach you how to move with the bar (or bars) in place. Walking will help increase strength and encourage deep breathing.
- Be discharged once you can walk without problems and do not require IV pain medications.
Recovery: What to Expect in the Next Few Weeks
- Most patients feel better after a week at home; however, caution must be taken when advancing movement, etc. Activities will be restricted for several weeks to ensure that the bar is secure in place.
- You may return to light activity, work, or school in two to three weeks and resume some exercise/sports in six to eight weeks. Your pediatric surgeon will advise which activities are safe and when you can participate in sports again. Alternative Names: Sunken chest
Questions & Answers
Below, find answers to common questions. Click each item to expand the Q&A for each section.
Under general anesthesia (completely asleep), several small incisions are made in the chest for insertion of the supportive bar. Tiny incisions are used to insert a thoracoscope (small telescope, attached to a video camera) into the chest. This gives a clear field to visualize placement of the bar. In some patients with large and/or stiff chest walls, two or even three bars are needed. Once the bar/bars is in place, the surgeon affixes it to the ribs on either side and closes the incisions. Bars will remain in place to help support chest development for two to three years and will be removed as an outpatient procedure.
While it may vary based on each case, most surgeries are completed in about two hours.
Normally, three to five days (range: 2-7 days).
Most patients recover in six weeks, but precautions must be taken during exercise/sports. The bars will be removed as an outpatient procedure in two to three years.
Although patients of any age can undergo correction, we feel that the “ideal chest” with the best flexibility and quickest postoperative recovery, is in patients who are about 12 years of age. However, since many children don’t develop significant deformities and/or symptoms until later in life, our average patient is about 14-16 years old. Approximately 20% of patients having this operation are adults. This operation has been successfully performed in patients in their 20’s, 30’s, 40’s, and 50’s.
Pectus excavatum is not usually a life-threatening condition. However, symptoms often get worse over time, and the chest wall naturally “stiffens up” as the body ages, which should be taken into consideration. This is not an emergency surgery, so patients usually have time to prepare for the procedure.
We encourage patients to be active. Patients can return to vigorous physical activity approximately two months after surgery. Remember that the bars are in place for two to three years and there may be at least some sensation of chest wall “restriction” (especially with vigorous breathing) while the bars are in place. This typically resolves once the hardware (bars) are removed.