Medically Reviewed by J. Duncan Phillips, MD, FACS, FAAP

While many people have never heard of a chest wall deformity, the pediatric surgery team at WakeMed Children’s – Chest Wall Deformity Center sees children almost daily for conditions that range from mild to severe.

Chest wall deformities are usually developmental anomalies that occur during childhood growth and development though they may follow serious, traumatic injuries. An abnormally shaped chest may be present at birth or may develop later at different ages and stages of growth. While chest wall deformities can be diagnosed and treated in babies as young as a few months old, or in adults in their 70’s, the most common chest wall deformities develop and are diagnosed during an adolescent growth spurt.

Symptoms of a chest wall deformity may include the following:

• Fatigue during exercise
• Shortness of breath
• Dizziness
• A racing heartbeat
• Chest discomfort or pain

A child might not have or report these symptoms, and many times a parent or physician will notice the abnormal chest shape before the child. A chest wall deformity may be caught during an athletic physical or by a pulmonologist examining a child with symptoms similar to asthma, which may be due to compression of the heart and/or lungs.

Parents may notice their child has a caved-in or protruding bird-like chest, but young kids usually aren’t bothered by it. Older children and teens may notice a change, but some won’t say anything. Parents may notice their child is shying away from social settings, such as pools or shared dressing areas.

Two Common Conditions

Pectus excavatum is an abnormal configuration of the chest, where the sternum (breast bone) pushes into the heart and lungs. This gives the chest a caved-in or sunken appearance.

Pectus carinatum is a forward protrusion of the sternum (breast bone) and/or ribs. This is described by some as a bird-like chest appearance.

Get Checked Early

While there can be some anxiety of the unknown, it is best to get children seen as early as possible.

“People just need to schedule a time and talk with us,” says Dr. J. Duncan Phillips, MD, Surgeon-in-Chief and Director, WakeMed Children’s – Pediatric Surgery. “Frequently, an assumption is when you meet with a surgeon you’re being signed up for surgery; that’s simply not true. There are a lot of minimally invasive treatments. Our goal is to determine what each patient truly needs to get back on track with their life.”

He advises families to avoid spending a lot of time searching online because there is a lot of confusing and outdated information about chest wall conditions and treatments.

Early cases of some chest wall deformities (specifically those described as ‘bird chest’) can be treated with a brace to eliminate the need for surgery.

A common misconception is that children will grow out of the defect.

“In fact, most do not,” said J. David Hoover, MD, FACS, WakeMed Children’s – Pediatric Surgery. “They may not get worse, but we usually see the defect getting more pronounced in older, untreated children.” As the chest wall stiffens, corrective options are reduced.

While chest wall abnormalities are more commonly reported among boys, many girls have gone undiagnosed due to their breasts covering a significant deformity.

Treatment Timing

Surgery is typically done during the mid-teen years, but earlier interventions are recommended at times for younger children who are very symptomatic. Once corrected, recurrence is not very common.

If a child needs surgery, a bar will likely be used to correct the sternum. Many children report relief following surgery.

Comfort & Convenience

A major concern for children and adults undergoing chest wall surgery is adequate relief of perioperative pain.

“Relief strategies may involve a combination of modalities, depending upon the particular patient, age and chest configuration. We have found that there is no one size fits all approach,” explains Dr. Phillips. “We are always seeking new ways to optimize comfort and healing for each, individual patient.

“In recent years, we have made significant strides in reducing pain by using cryoablation of the intercostal nerves (freezing of the inside of nerves) during the Nuss procedure to repair pectus excavatum, which is the most common chest wall deformity condition,” comments Dr. Phillips. “Patients are going home sooner, with minimal pain and a greatly reduced need for medication because the nerves that are frozen during the procedure can remain numb for three or four months, which creates a dramatic difference in our patients’ postoperative recovery experience.”

WakeMed also employs Enhanced Recovery After Surgery (ERAS) protocols for patients. While high-volume centers typically average three days of inpatient care after surgery, the average postoperative length of stay for WakeMed patients is about two days.

Team Approach

WakeMed Children’s – Pediatric Surgery team works collaboratively with many disciplines to provide the most comprehensive evaluation and treatment for patients diagnosed with chest wall deformities – all in one convenient location. With decades of experience in the treatment of chest wall deformities and four dedicated pediatric surgeons, more than 80 chest wall procedures are provided each year.

“There are a lot of benefits for patients receiving care at WakeMed Children’s, since it is a hospital within a hospital,” said Dr. Phillips. “The people you need are right down the hall, and we all work together in the best interest of each patient.”

As one of the region’s largest health systems and home to a Level 1 Trauma Center, WakeMed has dedicated pediatric providers and teams available around-the-clock in areas such as radiology, anesthesia, physical therapy, intensive care, orthopaedics, pulmonology and cardiology. In addition, WakeMed’s child life specialists are available to help children and families cope with any stress or anxiety while at the hospital.

As the busiest and most experienced chest wall treatment center in the southeast, WakeMed and its expert team of surgeons and partnering specialists provides the most advanced treatment options available – treating everything from the most common conditions to the most complex problems. When it comes to caring for chest wall surgeries, no one has more experience than WakeMed, and the team is committed to highly specialized care.

OUR PATIENTS, CARE & OUTCOMES

• 19% Female
• 81% Male
• 16.1 Average age
• 5%* Average complication rate
• About 2 days average post-operative length of stay

Chest Wall Corrections for Adults

Through collaboration with WakeMed’s adult cardiothoracic team, corrections for adults have really changed things over the years so more and more patients of all ages are turning to WakeMed’s Chest Wall Deformity Center for the best possible options.

Dr. Phillips explained, “Many of the patients we see are in their 20s or 30s, and they are reassured by the collaboration and extensive experience among our team and partners.”

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About J. Duncan Phillips, MD, FACS, FAAP

Dr. Phillips serves as the surgeon-in-chief of WakeMed Children’s Hospital and the director of Pediatric Surgery for the physician practices of WakeMed Health & Hospitals.

He majored in Bioengineering and received his undergraduate degree from the University of California at San Diego. He earned his medical degree from the University of California at San Francisco and then completed his general surgery residency at the University of California – Los Angeles.

During his residency, he completed a two-year research fellowship and a clinical fellowship in ECMO (extra-corporeal membrane oxygenation) therapy of critically-ill neonates. He then completed a two-year clinical fellowship in Pediatric Surgery at the Children’s Hospital of Los Angeles.

Dr. Phillips was Assistant Professor of Surgery at the University of Southern California School of Medicine and Attending Surgeon at the Children’s Hospital of Los Angeles from 1995 to 1999. He developed a special interest in minimally-invasive surgical procedures in children, including laparoscopy and thoracoscopy, and was an instructor at multiple advanced pediatric laparoscopy courses.

Dr. Phillips moved to North Carolina in 1999. He was Associate Professor of Surgery at the University of North Carolina-Chapel Hill School of Medicine and Attending Surgeon at the North Carolina Children’s Hospital from 1999 to 2010.

Dr. Phillips is board-certified in both General Surgery and Pediatric Surgery. He is a Fellow in the American College of Surgeons and in the American Academy of Pediatrics. He is a member of multiple specialty societies, including American College of Surgeons, American Pediatric Surgical Association, American Academy of Pediatrics, North Carolina Pediatric Society, International Pediatric Endosurgery Group, Chest Wall International Group, and Pacific Association of Pediatric Surgeons. He is married, with two children.

About WakeMed Pediatric Surgery

Welcome to WakeMed Children’s – Pediatric Surgery. Our pediatric surgeons specialize in performing advanced surgical procedures in newborns, infants, toddlers, children and adolescents with locations in east Raleigh, Clayton, Apex and North Raleigh, N.C.

Our dedicated providers work closely with children and their families throughout the surgical process. From pre-surgical consults to post-surgical care, our team offers the highest level of surgical care and caring for children who require both routine and highly specialized procedures.

This blog is adapted from an article in our Families First Magazine. Interested in getting future issues of Families First delivered to your home? Subscribe here.