Scientific paper
Management of pectus chest deformities in female patients

https://doi.org/10.1016/j.amjsurg.2003.11.010Get rights and content

Abstract

Background

There is sparse published information regarding surgical management of females with pectus excavatum (PE) or carinatum (PC) deformities.

Methods

During the past 33 years 104 females with PE, and 21 with PC underwent surgical repair using extensive modifications of the Ravitch technique. Seven had previous right breast implants, 3 had prostheses placed in the PE deformity. Nine PE patients underwent successful pregnancy before repair, but had severe third trimester dyspnea.

Results

Very good to excellent results were reported by 96% (mean follow-up, 6 years). Increased endurance, decreased dyspnea, reduced chest discomfort, and less tachycardia occurred in all within 6 months. No patients had significant breast asymmetry after repair. Complications included mildly hypertrophic scar (8), transient pleural effusion (3), bar displacement (1), and mild recurrence (3).

Conclusions

Females with symptomatic PE or PC, can be repaired with low morbidity, mild pain, low cost, and improvement in body image and symptoms. Prostheses are not beneficial in the treatment of physiologic symptoms caused by pectus deformities.

Section snippets

Methods

The medical records of all female patients who underwent repair of PE and PC deformities at UCLA Medical Center from January 1970 through April 2003 were retrospectively reviewed. During this 33-year period 104 females underwent repair of PE, and 21 had correction of PC deformities. Five females with Poland's syndrome were excluded from the review. Ninety-three patients underwent repair within the past 8 years. During this same period 645 males underwent repair of pectus deformities. The ages

Results

An attempt was made to contact each of the 125 patients by telephone, e-mail, or questionnaire from 5 months to 14 years after operation (mean follow-up - 6 years). Responses were obtained from 112 of the patients (90%). Twelve of the patients could not be located. One hundred seven of the 112 patients who responded indicated that they considered the result after repair to be very good or excellent (96%), and that they would recommend repair of pectus deformities to other patients (Fig. 4, Fig.

Comments

Symptoms from PE are uncommon during early childhood unless the patient is one of the few in whom the depression is unusually severe. Repair of PE in preadolescent asymptomatic patients using techniques that resect a major portion of the deformed costal cartilages have been discouraged in recent years because removing large segments of costal cartilage in young children may interfere with the rib growth and produce a narrow chest [9]. Haller et al [10] have cautioned against extensive cartilage

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