Pectus Excavatum and Carinatum

Small Incision Sternoplasty (S.I.S) is a new surgical procedure developed in New Zealand to treat the relatively rare conditions of Pectus Excavatum and Carinatum. Pectus Excavatum (or "funnel chest deformity") involves a chest wall appearance which is "sunken in" at the front. This may occur in a symmetrical fashion or at times with a "twist" to one side. Pectus Carinatum ("pigeon chest deformity") is the opposite outward protrusion of the chest wall.

The S.I.S technique arose as a result of our frustration with the current techniques of repair which are far from perfect or versatile. Even newer techniques such as the Nuss bar procedure suffer from several major drawbacks. This procedure is most effective really only in the younger age group (teenagers), involves significant postoperative pain (somestimes for months and which can stop strenuous physical activity) and involves a variable degree of relapse of the deformity once the bar is removed. There are also rare but serious reported complication in the literature. The other drawback is the fact that it is not able to be used to treat an assymetrical pectus excavatum or pectus carinatum effectively. 

We have recently reported our experience with the first 3 years of the new technique of Small Incision Sternoplasty at the 2014 New Zealand Association of Plastic Surgeons (NZAPS) Annual Scientific Congress. The S.I.S procedure involves the smallest incision of all available surgical techniques (average 7cm) and is able to correct all forms of anterior chest wall deformity. This includes symmetrical and assymetrical Pectus Excavatum and Carinatum. We reported stable results at 3 years followup and the procedure is effective in older patients (oldest patient to date has been 42). 

We also looked at the psychosocial aspects and impact of surgical correction in patients. This is often ignored or poorly reported in the surgical literature. 75% of our patients reported significant teasing from peers. Patients were also asked to rate their self Body Image Perception from 0 (worst body image) to 10 (excellent body image). Our findings showed a mean Pre-operative Body Image Score of 3 and a mean Post-operative BIS of 8.5.

Overall we were very pleased to be able to report that the SIS is a safe and effective technique with excellent patient satisfaction and surprisingly quick return to activity after surgery. This novel technique is currently being prepared for publication in a scientific journal and has rapidly become our standard technique for surgery in these conditions.

I would typically perform the SIS procedure in most teenage and all adult patients with anterior chest wall deformity. The procedure is performed under a general anaesthetic with an inpatient hospital stay of 3-5 days. Typically patients can resume most physical activities in 4 to 6 weeks. Obviously a thorough preoperative consultation is necessary to talk through the surgical options and recommend the form of treatment that is most suitable to your individual situation.