funnel chest. It is usually noted after birth but in some people it is not visible until they are older as the deformity can be unpredictably progressive. The exact cause is not known but it is more common in males than females. It is believed to be due to overgrowth of the rib cartilage adjacent to the breastbone (sternum) which pushes the breastbone backwards. Most people have no symptoms but if the breastbone is pushed back far enough heart & lung function can be compromised. One could then have curvature of the spine, shortness of breath on exertion, heart palpitations, limitation of ability to perform strenuous activity. Surgery is required for cosmetic reasons & in more advanced cases to improve heart & lung function.
Infants with compromised heart/lung function should undergo surgery early. This involves cutting the breastbone & rib cartilage & either flipping the breast bone over or making cuts to allow bending of the bone. A recent surgical advancement involves making 2 small incisions on either side of the chest. Using endoscopic guidance to free up chest tissues & then inserting a metal bar that pushes the caved in area forward. A few months later the bar is removed. The surgery is simpler, has a quicker recovery time & gives as good or better results. For smaller purely cosmetic deformities (no functional deficit) especially in adults custom made implants are used to camouflage the defect. Because of the great variablity of deformity among those who have this deformity the implant must be custom made. A plaster model is made of the deformity in the plastic surgeon’s office. The model is then sent to the manufacturer who makes a custom silicone implant. The implant is inserted via a horizontal incision in the natural crease between the chest & abdomen. Because the actual bone depression may be smaller than the grossly visible external surface defect some intraoperative adjustment of the implant may be required.