A funnel, caved-in or sunken front chest wall is caused when several ribs and the sternum grow abnormally. It is usually present at birth and worsens with rapid bone growth in the early teens, but in rare cases does not appear until puberty. There are a number of options available to address this condition, so you are welcome to discuss these issues with us during a consultation.
We recommend three surgical procedures, based on each patient’s needs:
For marked chest wall asymmetry or significant restriction of heart and/or lung function.
During surgery: A skin incision is made and the breastbone is divided, rib cartilages are cut and re-shaped, placing the sternum in the correct position. Muscle and skin are then closed over the reconstructed chest wall. Allow a five-day hospital stay and at least three months off sport while you heal and strengthen.
Nuss Bar technique
For a symmetric sunken chest, especially in older children and teenagers, who have a flexible chest wall.
During surgery: This procedure accesses the chest through two small, lateral incisions, and places a custom-shaped, concave, flat steel bar into the chest, underneath the sternum, using adjacent ribs as leverage. Once inserted, the bar is flipped to a convex position, and pushes outward on the sternum. In children, the bar is usually removed after three years to allow normal growth of the chest. Adults do not need to have the bar removed, but they may choose to do this.
For adults whose major concern is appearance rather than functional impairment, a simpler, less invasive cosmetic procedure is available.
During surgery: A custom-made solid silicon implant is inserted and hidden in a chest/upper abdominal “pocket” beneath the pectoralis major muscles. This fills in the hollowed chest, creating a more normal contour. Because the implant is solid silicon, there is no risk of silicon leakage or toxicity and as the implant is fixed to the rib cartilages with permanent sutures, it is soon encapsulated by the body and does not move around with daily activity. After 6 to 12 weeks, patients can get back to their sport, even contact sports and bodybuilding.
In patients who have minor contour abnormalities after correction by one of the above methods, injectable fillers may be used.