The ideal age for intervention in patients with symptomatic Pectus Excavatum is from 8 years old to pre-pubescence, 12-14 years old (adolescents prior to growth spurt) to avoid the possible complications arising from the disease itself and the psychological problems. That being said, thanks to the simplicity of the Pectus Up technique, adult patients can also benefit from surgical treatment with this new technique.
In pediatric patients, surgical repair of Pectus Excavatum used to be advised in symptomatic cases as soon as possible. However, it has recently been shown that the results are not as positive in very young children and, for this reason, it is currently recommended to delay the age of surgery, establishing the optimal age from 8 years.
There is no age limit, although treatment should be made the earlier the better, in order to avoid possible complications arising from the disease itself and the psychological problems that may appear.
Thanks to the ease of the technique, adult patients can also benefit from surgical treatment. Patients have been operated on with good results up to 46 years old, although these are exceptional cases.
Surgical indication will always depend on the type and grade of the Pectus Excavatum and the morphology of the patient, and not so much on his/her age.
There is a genetic predisposition towards these anomalies. Hereditary Pectus Excavatum has been observed in approximately 35-45% of cases.
It is always recommended to exercise so that the patient uses a correct posture and improves his/her physical condition. In people affected by Pectus Excavatum it is advisable to stretch and make breathing exercises to increase lung capacity. It is also advisable to practice swimming since it facilitates this as well as it strengthens the muscles.
Gymnastic exercises will serve as a complement to provide improvements in terms of breathing, strength and endurance, without there being a correction of the deformity, although an improvement in the muscular and physical part in general. Exercises for building muscle in the upper trunk area can improve the aesthetic appearance, although caution should be taken since sometimes the result may turn out to be the opposite, i.e. that the sinking is even more noticeable. We advise seeking advice from specialists in this area.
The best option for improvement is undoubtedly stretching, since it allows the chest to be expanded so that the cartilage attached to the sternum and the adjacent ribs adapt to use an upright posture.
Therefore, stretching will be key in correcting, some way, the appearance of the Pectus Excavatum. It must not be forgotten that warm-up exercises will be essential for good adaptation and to avoid overstretching different parts of the body.
The indication to undergo surgical treatment with Pectus Up will be based on the clinical diagnosis of Pectus Excavatum, and on meeting the criteria described in the Pectus Excavatum treatment section of this website. However, the decision will always depend on the surgeon’s judgment and the patient’s acceptance.
The indication for surgical treatment of Pectus Excavatum, in general, will be conditioned by the physical or psychological criteria that justify the procedure. In the case of treatment with the new implant Pectus Up, both mild and severe cases can be corrected with a high success rate, although this will always depend on each particular patient. In very specific and complex cases, the Pectus Up technique can be complemented with other surgical procedures.
The size will depend on the dimension of the chest and the degree of the Pectus Excavatum, always depending on each particular patient.
Until the end of October 2021, more than 170 surgeries have been performed on patients with Pectus Excavatum of different ages and degrees of severity. Among them, some have wanted to share their experience in a testimony format that can be found in the Testimonials section of the Patients section of this website.
The surgeries have been performed in countries such as Spain, France, Portugal, Ireland, Greece, Colombia, Mexico and Chile. The first case was performed in 2012, and 15 implants have already been removed with good results. Publication of the cases are being written by the specialized centers.
No. The Pectus Up technique is minimally invasive, involving an extrathoracic and non-risky surgical repair of the Pectus Excavatum. But when using general anesthesia, it cannot be ruled out that the patient experiences a complication, as in any other surgical procedure under these same conditions.
Yes, the patient will undergo general anesthesia in a conventional operating room. It is not ruled out that in the medium term the surgery can be performed as aMajor Outpatient Surgery.
Patients usually stay in the hospital for 1 to 3 days after surgical repair, depending on the age and grade of the Pectus Excavatum.
The typical scar size is some 3-4 cm wide.
Care must be taken with personal hygiene to avoid possible infections. The wound may not be touched or get wet. In addition, the dressing must not be removed until after the first post-operative examination by the surgeon. Several daily deep breathing exercises are recommended.
If the wound undergoes any changes, such as suppuration, swelling and/or opening of a part, the patient shall ask the surgeon or the hospital.
It is necessary to follow the instructions of the prescribed analgesic therapy after medical discharge. In the case of experiencing pain, patients can take the pain relievers recommended by the surgeon, and if it persists, they shall contact him.
Scheduled analgesia, as prescribed, mostly ibuprofen or paracetamol.
Good posture should be maintained.
Abnormal or rigid positions apparently pain helping with pain reduction should not be used, since that may be the cause of other subsequent alterations.
It is not advisable to stay in a lying position for a long time.
It is advisable to sleep on your back and to avoid lying on your side overnight (at least for the first 3 months).
The patient must avoid the exposure to risky situations, crowded environments and violent physical contact.
Do not twist the thorax abruptly, lift weights nor carry backpacks during the first month.
This is relative. The reference would be a person who has family, work, social or academic activities and a medium-low level of physical activity (without activities entailing a high level of risk).
After Pectus Excavatum surgical repair with the Pectus Up, the patient should remain at rest for about a week after surgery, and then at relative rest of approximately one month.
Sleep on their back and avoid lying on their side overnight (at least for the first 3 months).
The rest period is around a week after the surgery. Relative rest of one month is strongly recommended.
This will consist of gradually resuming daily activities, mantaining good posture and avoiding movements that cause pain. Refrain from any sporting activity for 3 months after the operation including heavy weight lifting.
Patients can go to school or usual work two weeks after the surgery, always respecting the surgeon’s recommendations.
Relative rest, trying to avoid movements that cause pain, and gradually resume activities of daily living.
Perform gentle breathing exercises on a daily basis, such as breathing in gently until the chest is completely filled; then slowly exhale until the lung is airless.
Patients can move the torso and raise arms gradually, progressively adapting to the new situation, without causing pain.
Always depending on the evolution of each patient, bearing in mind that the recovery is faster the younger the person is, patients can go to school, university or regular work from the first examination by the surgeon, if the surgeon considers it and the patient feels well.
They also can start sports activity about the first three months after the surgery, depending of the kind of the activity but refraining from high risk sports or those involving movement of the torso, such as golf, tennis, etc., for a period of 6 months.
Metall fixation devices or implants in general are not capable of withstanding the levels of activity and loads that a normal and healthy chest wall can tolerate.
If the instructions recommended by your thoracic surgeon are not followed, the Pectus Up implant may become loose, move or dislodged if it is subjected to weight bearing, loads or very intense activities, or if the patient suffers traumatic injuries to the thorax.
Failure to comply with postoperative instructions may lead to complications. See Complications section.
Generally, start back at sport activities 3 months after the operation will depend on the sport of practice (e.g: golf and tennis require more time), since these sports involve a broad movement of the torso. It will always depend on the consent of the surgeon.
After the surgery, activities of daily living should be resumed progressively, avoiding movements that can cause pain.
Sports activities can be done at school one month after the intervention, although it will depend on the type of activity. It is advisable to consult the surgeon in case he considers it convenient.
Avoid violent physical contact. You should avoid doing torso rotations and lifting weights during the first month.
What sports should be avoided?
Do not start intense sports activity before 6 months from the surgery, as well as refrain sports that involve torso movement such as golf, swimming tennis, weight lifting in the gym such bench pressing etc., depending on the thorax and surgeon’s approval.
Avoid all high-contact sports. No contact sports are recommended for at least the first 6 months after implantation because severe trauma to the anterior part of the thorax can cause serious intrathoracic injuries. In case of doubt, follow the surgeon’s criteria.
Patients can travel on vacation, as long as they maintain a good trunk position and avoid exposing themselves to risky situations.
Do not lift or hold suitcases, or lift weights, for at least one month.
Avoid crowded environments.
The device can test positive on the metal detector. It is advisable to carry a document from your surgeon indicating the presence of the metallic implant in the chest.
Initially it remains implanted for about 3-4 years, but in some cases it can be longer and even permanently. This will always depend on the age and especially on the evolution of each specific patient, and pending surgeon’s approval.
No. It is a very simple intervention and is usually performed without the need for hospitalisation in adolescent and adult patients. Once the implant is removed, the patient can make normal life at the social, academic and professional level.
Which are the possible side effects after the intervention?
The implant or any of its components can be loosened, displaced, or broken.
Reactions due to sensitivity to metals or allergic reaction to implant material can occur.
Abnormal pain, discomfort or sensation due to the presence of the implanted product can occur.
Irritation, wound infection.
Incomplete or inadequate correction of the deformity or recurrence of the deformity, before or after removal of the implant.
Removal of the implant may be necessary if you experience side effects due to one of the above points.
CT scans may be performed, although the image of the chest may be somewhat distorted (artifacts). NO MRI SCANS CAN BE DONE.
In very, very thin patients, the plate may sometimes be noticed under the skin in the central area. If the surgeon considers this possibility, a small modification can be made in the technique at the end of the surgery. In the other areas, visualization is not possible since it is not a subpectoral implant.