My son has started having breathing troubles from his Pectus. His preliminary Haller is 2.9 with a Correction Index of 25%. I know that the CI is a measurement of how close the sternum is to the spine, but I can’t seem to find anything about what this number actually means when it comes to the severity of the Pectus. My son is 14 and the more he grows, the worse it gets. Any advice would be greatly appreciated!

I’m 17 y/o I got the bar put it at 14 and I finally just got it removed today, absolutely stoked that I get to keep the bar. The surgery doesn’t hurt even half as bad as the original procedure but don’t get me wrong it still hurts, recovery time is anywhere from 3 to 6 weeks nothing compared to the 3 months of the original.

Wondering if I need a gp scan

for those in sydney who went through the whole process from gp to specialist to surgery,

did your gp have some knowledge of pectus and approve a referral for a ct scan instead of referring to a specialist, saying you have to get a ct scan referral from them. for those who got referred for a ct scan from their gp, who do you recommend?

from my understanding (correct me if im wrong), the first visit to your specialist is covered mostly by medicare and then recurring visits will incur full fee?

So wouldnt it make sense that a referral from a gp for a ct scan before a visit to the specialist would be optimal in saving money and avoiding the long waitlist again on having to book the appointment just to discuss the results of the scans when that couldve been done on the initial visit if scans were done before? TIA

Hi 👋 If you live in the UK, the nhs is about to launch a trial being championed by a clinic at St George’s hospital. The trial will be ran at 6 centres in the uk and will be available through the nhs. As part of the trial they will run thorough testing on the effects of the condition before and after surgery (nus).

If you’re in the uk and think you’re suffering the effects of the condition then go see your doctor and get referred.

I have another question--I asked my daughters doctor if we could do an MRI rather than CT to look/calculate. She said it would need to be a CT. Is that accurate in your experience?

Y'all have been awesome. My daughter finally had her first visit with a pediatric surgeon specializing in Pectus. She will have her CT next week. But, I learned a few things at her appointment that i had not heard before. One was that every pectus patient she has also has a Cafe-Au-Lait spot (or a few). Including my daughter :) She said she wasn't entirely sure why but that it was just something with the gene. Interesting :)

Y'all have been awesome. My daughter finally had her first visit with a pediatric surgeon specializing in Pectus. She will have her CT next week. But, I learned a few things at her appointment that i had not heard before. One was that every pectus patient she has also has a Cafe-Au-Lait spot (or a few). Including my daughter :) She said she wasn't entirely sure why but that it was just something with the gene. Interesting :)

Lately I've been having a lot more issues connected to my PE - I faint almost constantly, rapid heart beat, and feeling like someone's choking me.

So I finally got my MRI done, and it does confirm why this is happening - my rib cage is dented in, but ...flat. My lung capacity test showed FVC as 72%, and I was tested for Marfans and EDS, but don't have the results yet.

The radiologists didn't give me an official HI, and I'm yet to see my surgeon again to show him this, but calculating it myself gives me ~6 or ~7.5 for the second one. Even the "nicest" slice i could find had an index of a bit above 5.

My question npw is...how corectable is this with the nuss procedure? I am in pain and am honestly fed up at this point. :( It's ofc primarily for my health concerns, but it's also the visual and mental aspect, as I can't look at myself in the mirror anymore shirtless without wanting to cry, and I can't do normal life things anymore as I used to.

I'll take any advice you can really give to me, to be honest :) I'm located in Berlin, was at Charite's Thorax clinic.

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Anybody know a doc that has a good rep for dealing with PE? Thanks!

I am officially 3 weeks post-Nuss! This sub helped me a lot through the whole process. One thing I found most helpful was when people shared their whole experience from beginning to end, so I figured I would do the same, just in case it helps someone with a similar fact pattern.

I knew I had pectus from a young age, like many of you in this sub, I was told it was just cosmetic by my pediatrician. While it always made me a bit insecure, I never really considered getting it fixed and never really looked further into it. I never noticed any symptoms either, or if I did have symptoms, they were mild enough that I could ignore them or assumed this is just how everyone feels.

Fast forward to 2019, I'm 28yrs old and I hurt my knee when running a 5k. It seemed like a typical IT Band issue and after self-diagnosing failed, I ended up getting physical therapy and while it helped, I never full got rid of the knee issue. I had almost resigned to just never being able to run more than a mile again. After 5yrs of persistent knee issues I decided maybe the IT Band problem is coming from something else. I learned that a bad anterior pelvic tilt can cause IT Band issues. I thought maybe my IT Band problem isn't from the usual weak glutes and hips or bad running form, but instead from bad posture. I start looking into what causes anterior pelvic tilt and how to fix it. I stumble on an article that listed pectus excavatum as one of the less common causes of anterior pelvic tilt. Now I am wondering, "is this stupid pectus thing from my childhood giving me awful posture, which is causing my hip flexors to be tight and my core to be weak, which is why my IT Band seems to be perpetually irritated?" So I start looking into ways to "fix" pectus excavatum and find this subreddit. Suddenly I am seeing a lot of pictures of people who look similar to me, and I'm reading stories about how they required surgery, their pediatrician was uniformed, and they have heart and lung issues, etc. I decided to discuss this with my doctor at my next annual physical.

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Go figure, my primary care doctor knew nothing of pectus excavatum and had to look up the condition in the office with me. She didn't even look at my chest or ask any real questions. However, credit where credit is due, she was receptive to what I was saying and scheduled me to get a CT Scan. The scan came back with an Haller Index of 2.7 and "some indentation on the anterior aspect of the right ventricle by the sternum". I was happy to see a relatively low Haller Index, but concerned that my sternum was indenting my heart ventricle. I expressed the concerns to my doctor, she agreed and said the next step would be to see a thoracic surgeon.

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I had learned from this sub that even many thoracic surgeons don't know much about pectus, so I used health grades to search for thoracic surgeons within 100 miles of me that specifically mention pectus in their profile. There was only one, Dr. Julian Guitron at Christ Health in Cincinnati. Thankfully his reviews were stellar and he was in network. I later found out he was trained by Dr. Garcia from Cincinnati Children's. Dr. Garcia is mentioned a lot in this sub as being one of the best. Apparently he was getting more and more requests from adults with pectus. I'm not sure what the age cutoff at Cincinnati Children's is, but it became apparent to Dr. Garcia that a surgeon was needed in the area to work on adults. He partnered with Christ Health and personally trained Dr. Guitron. This gave me a lot of reassurance that I was in good hands. On my first visit with Dr. Guitron he told me he thinks I'm going to qualify for surgery. He informed me that Haller Index is a threshold for insurance purposes and while the measurement is important he finds the corrective index to be a better measure and my CI indicates I need surgery. He visually examined me and thought my pectus appeared worse in person then my scan led on. He had me get the following tests in order to confirm his suspicions and to get insurance to approve surgery:

1. MRI - While Dr. Guitron did not request the MRI on both inhale and exhale, I specifically requested this when I went in for the MRI and they obliged. I was never given 2 separate Haller Indexes (inhale vs. exhale) but my Haller Index from the MRI came back far higher than the CT Scan with a 4.15 and also indicated I had reduced systolic function on both my right and left ventricles. For those who have never had an MRI, it took a little over an hour. I received on IV of contrast dye and headphones to listen to music that was periodically interrupted with instructions such as (take a deep breath and hold for 10 seconds or exhale and hold for 5 seconds). If you have claustrophobia, I would recommend keeping your eyes closed through the whole process, it's a tight squeeze in the MRI machine.

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2. CPET (Cardio pulmonary exercise test) - This is the test where they make you do a bunch of big breath exhales and inhales into a tube, then put you on a treadmill or exercise bike with a breathing mask and a bunch of heart monitors. As the test progresses you have have to maintain a certain RPM on the bike or pace on the treadmill as they slowly up the bike resistance or the treadmill speed. They took my blood pressure repeatedly through the exam and I had to periodically point to a chart to indicate me level of exertion. My test ended early because I maxed out the resistance on the exercise bike (I couldn't use the treadmill due to my IT Band knee issue). This frustrated me as the big number that comes of this test is your V02 Max. For any fitness nuts out there, you may know V02 Max is probably the best indicator of your cardiovascular fitness, so I was excited to see what mine was, but because they ended the test early, my results came back low at 37ml/kg/min (96% predicted). I told me doctor that I felt my V02 Max was much higher than this and the test wasn't performed well, but he assured me that even if it wasn't accurate the results indicate my pectus is likely having very little, if any impact on my lungs, which was good news.

3. X-Ray for scoliosis. Scoliosis is pretty common with Pectus. Thankfully, while I do have poor posture, a bad anterior pelvic tilt, and lower back pain, I did not have scoliosis

4. Heart Transthoracic Echocardiogram. This was an ultrasound of my heart. This test was the least discussed by my doctor. From my layman's reading of the results it appeared everything was normal so I just assumed there was nothing to discuss. The test was pretty easy, just laying on a bed for about 30mins with a few heart monitors on as a tech moved the ultrasound tool around on my chest and sides and had me do a couple of breath holds.

After all my tests, I reconvened with Dr. Guitron. He told me my pectus was "severe" but on the low end of severe. It is impacting my heart but likely not my lungs. He said because I'm relatively young and in shape my body is able to compensate for the negative heart impact now, resulting in minimal symptoms, other than occasional heart palpations. However, long term, the wear on my heart will take its toll and when I'm older my heart will likely be performing at the level of someone far older than my age. Basically when I'm 60, I may have the heart of an 80yr old. He said I may feel some near term improvements after I recover from surgery, but that will likely be minimal given my minimal symptoms now. I decided to move forward with the surgery.

In the days leading up to the surgery I had to:
- Return to the hospital to get an EKG and blood work to insure I was healthy enough for surgery, confirm my blood type, etc.
- Meet with Occupational Therapy to go over movement restrictions and how to do do basic functions post surgery (wipe my ass, put on a shirt, etc)
- Meet one last time with Dr. Guitron to go over any final questions. At this point I was getting very nervous, not just about the surgery, but I had learned from this sub that a catheter is not unusual. I asked him if I would wake up with catheter because I'd really rather not. He said he will remove it post surgery while I am still under anesthesia unless they were detecting any prostate issues where they think I may have trouble urinating post-op. Thankfully I was catheter free when I woke up (phew)! But as you'll see later, I "almost" regretted this.
- 3 days before surgery I was told me to begin a high carb, high protein diet and begin taking daily MiraLAX, a laxative to help with bowel movements. The anesthesia and pain meds post surgery can really back you up so they wanted everything moving and grooving down there.
- The day before surgery they had me take Senacot (a stool softener and laxative).
- 12hrs before surgery I had to stop all solid foods and they requested I drink 32oz of non-red/purple Gatorade.
- The night before surgery I had to shower and thoroughly scrub the surgical area with Hibiclens. The hospital provided this. It helps prevent infection.
- 6hrs before surgery I had to drink another 6oz of non-red/purple Gatorade and then stop all liquid intake
-Morning before surgery (my surgery was at 7am) I had to shower and scrub with Hibiclens again.

On the day of surgery I had to arrive 2hrs before my surgery time, so I got to the hospital at 5am. I figured I would be sitting around for a while, but I was in the waiting room for ~5mins when they called me back to pre-op. They placed an IV line with some saline, shaved my chest and stomach, checked my vitals and performed a pre-op screening. The physician's assistant came in and explained what they would be doing (the surgery and the cryoablation). They added something to my IV, not sure what, to help ease my nerves and then I was wheeled back to the operation room. I remember this being pretty intimidating. A huge, sterile, freezing cold operating room with tons of people bustling around, moving me onto the surgery table and then pretty quickly I was unconscious.

Dr. Guitron updated my wife in person after my surgery and said it was a best case scenario and everything went great. She said she received text updates throughout the procedure as well. I was brought into the PACU (post-anesthesia care unit). I was still pretty in and out and don't remember much of this but my wife said I was there for 4 hours.

Once I got to my room I was there for 4 nights. The first day was the worst. I threw up a few times from the pain meds. Zofran, an anti-nausea medication, didn't work for me. They provided a stronger anti-nausea via my IV and it worked wonders but made me very drowsy. I slept a lot but in small increments. I was woken up regularly to be given pain meds, blood thinning injections, and vital checks. I also had 3 X-Rays my first 3 days there. They tracked my urination via a portable urinal, and I was struggling to urinate. They did a bladder scan and said I had too much urine in my bladder and they needed to do a catheter. They didn't sugar coat this and said it would be very unpleasant. This really freaked me out, but last minute I was able to finally pee a significant amount and avoided the catheter! If this worries you, I advise trying to pee as much as possible as soon as possible.

On days 2 - 4 in the hospital I was going on more and more walks. Cardio-rehab would regularly come by to walk with me and then take my vitals. My wife also walked with my regularly. Everyone seemed to think I was doing really. The muscle relaxers were my "favorite" drug. They seemed to help the most and still do now 3 weeks later. Often times it's less so pain that I feel and more just incredible tightness across my chest. One strange issue I had in the hospital was my hands swelling and hurting. I've always had bad circulation in my hands and walking or standing with my hands down by my sides tends to make my hands pool with blood and they look red and more vascular. I guess having IVs in both hands exacerbated that and my hands would swell and turn purple after my walks. They eventually removed one of my IVs and that helped a lot. A recliner was provided in my hospital room, but I preferred the bed for sleeping and then hung out in the recliner during the day. I did end up moderately constipated and had to take a suppository.

After day 4 I got to go home! I was sent home with Gabapentin (100mg 3x/day), Acetaminophen (1,000mg 4x/day), Oxycodone (5-10mg 6x/day) and Methocarbamol (500mg 4x/day). They also told me I could incorporate Ibuprofen into the mix. I usually alternate Ibuprofen (800mg) with the Acetaminophen. I also took some supplements that I had read helped with surgical recovery and pain/inflammation (Bromelain, Curcumin, MSM, Glucosamine, and Collagen). I also had to continue taking laxatives and stool softeners until I got back to normal and reduced my intake of oxy. After about a week I was able to start dialing back my dosages and/or frequency. I'm 3 weeks post-op now and I'm taking medicine just 3x per day (morning, midday, and before bed). I only take 5mg of oxy before bed and I only take gabapentin 2x per day with the plan to slowly wean off of it entirely over the next week or so. The muscle relaxer I still take a full does 3x/day and the acetaminophen/ibuprofen I take a half doses 3x/day. I tried sleeping in bed with a big pillow wedge my first night home and it didn't go well, so I moved to the recliner and have been sleeping there since.

My biggest difficulties these days are that usually by the evening ~7pm I am feeling fairly fatigued and my upper back and left shoulder and trap tend to be very sore. Since I have reduced my meds, my chest is typically pretty tight and starting to get painful about an hour before I need to take my medicine, but it's definitely all bearable. I also have some notable swelling in my upper abdomen where the lowest part of the sternum attaches to my abs. According to my Dr. this is from the cryoablation and should go away in time. Emotionally, the hardest parts have been not being able to pick up my 11 month old daughter and not being able to go to the gym. My doctor advised I can start testing out some lower body workouts (bodyweight squats and lunges, exercise bike, etc) at 4 weeks and upper body exercise at 6 weeks post op, but I need to be very cognizant of my body and not to do any big twisting/jerking movements and use very light, if any, weight. Officially I can't lift anything greater than 5lbs for 12 weeks, but they told me that's a general guideline and to listen to my body. I may be ready a little sooner than that or it may take me a little longer depending on how things feel. I seem to be progressing very well, so they said I can likely ease some of my restrictions earlier. After 2 weeks I was allowed to start lifting my arms above 90 degrees so I've become more self-sufficient and don't need my wife's help to put on a shirt or wash my hair anymore. I was also given permission to return to work today (I work a desk job remotely).

I still have a long road ahead of me until I'm back to 100%. I will continue having follow-up with my surgeon until they're reduced to an annual visit for the next 5yrs when the bars come out. I hope this post resonates with someone and helps them understand the process. I'm also happy to answer any questions people might have.

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Here is one of those classic cases we came across in late September.

This time, it was a 13-year-old boy who’s been living with pectus excavatum since he was little. At first, it wasn’t a big deal—just a subtle dip in his chest that his family was keeping an eye on. But as he grew, things started to shift. By around age 10, his chest was noticeably more sunken, and he began feeling tightness and shortness of breath during any activity. It was tough on him, and that’s when his family decided it was time to get some help.

before surgery

severe chest depression

During the initial exam, it was clear his chest wall was deeply sunken, and we noticed rib flaring, especially on the left side. Imaging confirmed our worries: his heart was getting compressed, showing this was a serious case of pectus excavatum with rib flare. His family was anxious but determined to get him back to a healthy, active life.

rib flaring

After some careful prep, we went ahead with surgery under general anesthesia. We made small incisions on each side of his chest and used the Wung procedure to lift and support his chest wall. To tackle the rib flare, we applied a technique called pre-shaping just before putting in the bar, which really helped manage the flaring. The surgery took about an hour, and the outcome was beyond what we’d hoped for—it was a total game changer for him. 

Surgery for severe pectus excavatum can be challenging, especially when rib flare is involved. The classic Nuss procedure doesn’t always give us the results we’re looking for, which is why our team usually opts for the Wung procedure in complex cases like this one. Tackling that rib flare is also a crucial part of the treatment. In this case, the pre-shaping technique worked wonders. It’s pretty straightforward, but it really makes a big difference in shaping the chest wall just right before we insert the bar. 

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This young man can now look forward to a future where he can breathe freely and embrace life without the limitations that pectus excavatum brought him**—and he’s already been discharged!**

PS： The pictures and details have all been approved for sharing by the patient. 

I've been recovering for 2 months

For people who have HAD appointments or will have them, how long is the wait? Im getting all my scans and stuff done right now. Its been awhile since I had any surgery anything so I dont exactly know how this whole system works and its stressing the hell out.

I’m trying to watch trailer park boys but I’m laughing my ass off hopped up on pain meds and edibles and it hurts but it’s worth it.

pericardium/sternopericardial ligaments are attached to the sternum, would this mean when you pull the sternum forward, it would stretch the pericardium/sternopericardial ligaments?

Hi!

I found the following pdf article from Japan. You can also google "Uemura rib osteotomy with nuss" and you should find the article easily.

https://www.n-watanabe-hosp.jp/hab/wp-content/uploads/2021/03/2020Uemura_RibOsteotomy%E3%81%AE%E3%82%B3%E3%83%94%E3%83%BC.pdf

Has anyone had this kind of "modified" nuss surgery or does ayone know more about the subject?

The article is from the year 2020 so quite new.

Hi fellas, I recently found about the pectus implant to mask pectus, has any of you guys done this kind of surgery? How was it? Were you satisfied with the result?

Thank you

Good morning all! I am scheduled to have the Ravitch Procedure done next spring 2025 and I'm a little nervous. Since getting a little older and gaining weight, my pectus has given me lots of problems. The worst one is constant chest pain and rapid heartbeat. I've had all the tests to rule out heart problems. Doctors are certain surgery will fix the problems I'm having. But due to my age, the severity of the dent and the fact that it is quite asymmetrical, my surgeon wants to do the ravitch on me.

Who has had this done? What is the recovery like? When did you return to work? Were there any complications either during surgery or after? Any and all information is greatly appreciated in advance!! Thanks!!

I'm 9 months post op. I've done PT and regained my full range of motion and I'm not in daily "pain" per se, but by the end of the day I feel a lot of soreness and I end up taking Tylenol or ibuprofen a few times per week. I'm not comfortable lying on my sides yet...still feels too tender.

I'm 35 so I know I won't heal as fast as a 15 year old but it feels like I should be further along.

I'm wondering if there are vitamins or supplements that can help with the healing process..anyone have thoughts or experiences with that?

i get dizzy quite a bit and have had breathing difficulties as long as I can remember. Im 22 also