When Pectus Excavatum is Severe, Surgery May be the Answer

Felix Skeens knew something was wrong with his chest by the time he was 14 years old. Not just what it looked like, but how it felt. 

“I was at the beach with my family, and I noticed that other guys’ chests weren’t sunken in like mine,” says Felix, who lives in West Virginia. “I started to feel really self-conscious about it, so I would wear a shirt all the time in public. I also began noticing shortness of breath and chest pains when I’d exert myself physically.”

Felix asked his pediatrician about it, and she diagnosed him with pectus excavatum (PE). Also called funnel chest, PE is a depression or “dent” in the middle of the chest. It occurs because of an abnormal growth of the cartilage that attaches the sternum (breastbone) to the ribs. PE is more common in boys, and often becomes more obvious during puberty. In severe cases, the sternum pushes on the heart and lungs and can lead to serious medical problems.

“The pediatrician told me and my mom that the PE was just cosmetic, but I was sure it was affecting my heart and lungs somehow,” Felix says. “My symptoms got worse over the next few years, so my parents decided to get a second opinion.”

In November 2018 Felix and his parents, Phillip and Robin, saw Rebeccah Brown, MD, a pediatric surgeon and the co-director of the Chest Wall Center at Cincinnati Children’s. It happened to be Felix’s 18th birthday. 

Dr. Brown knew from simply looking at Felix’s chest that he would benefit from surgery to correct the defect. Tests confirmed that he needed surgery for medical—not just cosmetic—reasons. PE is measured on a scale called the Haller index. A normal Haller index is 2.5, and an index of 3.2 or higher is considered to be a severe case of pectus. Felix’s score was 6.7. Other tests showed that the sunken chest wall was restricting his heart and lung function, especially during exercise.

Dr. Brown explained that Felix’s surgery would involve lifting the sternum away from the heart and lungs, and inserting metal bars across the chest from one side to the other. The bars would stay in place for several years. This would give the sternum time to conform into a new, more normal position.

Most people need two metal bars for this repair, but Felix would need three since his chest deformity was deep. Dr. Brown cautioned Felix and his parents that the recovery would be painful, but that the entire care team would help him through it. 

The surgery took place on May 29, 2019, five days after Felix graduated from high school. “The pain really was bad, especially the first few days,” Felix says. “But as soon as I could get out of bed and get to the mirror in my hospital room, I did. I was so happy and amazed by how my chest looked.”

Close attention from his parents and the medical team helped Felix endure the pain during his hospital stay. “Dr. Brown checked on me at least once a day, and the nurses were amazing—no matter what I needed, they were there for me,” he says. “Everyone was really reassuring and sympathetic, and that calmed me down.”

Felix returned home and spent the next 12 weeks recovering, most of it in a recliner in his living room. Friends came to visit and Netflix helped pass the time. By mid-August he was feeling good and ready to begin the next important phase of his life: college. He is taking a full course load at a local college and plans to become a nurse.

“It was a tough summer, but it was totally worth it to have the surgery,” he says. “I don’t think I realized how compromised my breathing was before. Now I can take deep breaths, and my chest and back don’t hurt like they used to. And like I said, my chest looks so good! I feel a lot more confident now.”