Funnel breast

• Figure rib cage

Synonyms

• Pectus infundibiliforme (lat .; funnel-shaped breast)
• Pectus excavatum (lat .: hollowed chest)

English: funnel chest

definition

The funnel chest is a deformation of the chest wall that is congenital. The ribs grow faster than the breastbone and this creates a central retraction of the chest. The spine is not affected.

Summary

The funnel chest is a congenital retraction of the central chest caused by a disproportion in the growth rates of ribs and sternum.
Boys are more likely to be affected than girls, and there is also a familial accumulation.

Depending on the extent of the retraction of the chest in a funnel chest, complaints arise. The most dangerous thing is the displacement of the heart, which is less serious in the first decades of life, since the entire chest is still very elastic.
However, complaints can arise during sport because the heart cannot develop its full pumping capacity. The therapy is conservative. Surgical intervention is only necessary in the event of severe displacement of the heart with (possible) functional impairment. But the psychological aspect must not be ignored either. Most patients suffer from their funnel chest. In these cases, surgical intervention must be well thought out, because here too - as with any operation - dangers and complications lurk. After the operation of a funnel breast, the prognosis is good, but the patient must take care of himself in any case and even the most natural areas of everyday life (such as sleeping) are restricted.

Figure rib cage

1. 1st rib
2. 12th rib
3. Breastbone / sternum
4. Ribs - sternum - joint

The cartilage part of the rib is blue (see ribs).

Epidemiology

In about half of the cases familial accumulations known. Especially tall, slim people (Asthenic) are affected. The ailment does not show itself to its full extent until around 6 to 10 years of age.

Is a funnel breast inheritable?

The funnel breast actually occurs in families. In a third of those affected, other family members have a funnel breast, which suggests a genetic component in the development of this malformation. However, it has not yet been clarified which genes are affected.

Funnel breast in the baby

In over 80% of people who have a funnel breast, this is noticeable at birth or during the first year of life. Boys are about three to four times more likely to be affected than girls.

In total, around 0.5 to 1% of all children are affected. The cause can either be genetic or idiopathic, which means that no genetic basis can be established.

In childhood and adolescence, patients are often symptom-free because the chest is still very elastic. With increasing age, often in the course of puberty, symptoms can nevertheless develop. In some cases, however, the funnel breast can still regress around the age of two to three years.

The rule is that if you have no symptoms until puberty, there is basically no need for medical action. Regular follow-up checks should be carried out and, if necessary, physiotherapy or posture training should be carried out. Treatment with the suction cup is also an option. Here an attempt is made to pull the chest forward by creating negative pressure on the breastbone. This method of treatment takes a few months to years and must be done regularly. Often, in addition to the funnel chest, other orthopedic findings arise due to the incorrect posture of the upper body. These include the hunched back and scoliosis.

However, if physical symptoms occur, there is an urgent need for action and surgical correction is unavoidable. Possible symptoms include displacement or crushing of the heart or other organs, such as the lungs. This can limit physical performance.

Added to this is the psychological stress that can arise as the child ages.

An operation should be performed from the age of 12 at the earliest, as otherwise there is a risk that the funnel breast will develop again in the course of growth.

causes

As a rule, a funnel breast is congenital. The Ribs grow faster than that Sternum. However, factors such as the children's soft costal cartilage and mechanical forces also play a role.

Symptoms

There are quite different shapes for the funnel breast: there are wide and pointed indentations. Depending on how deep the indentations are, complaints arise. For example, the mediastinum (Mid-head space) narrow. The mediastinum is the space behind the breastbone where the heart is located. The spine is not affected, but can become deformed over time as a result of the incorrect loading and lose its function.

Children and adolescents are usually symptom-free because the chest is very elastic at a young age. In addition, as the body progresses gradually, the organs have time to adjust. With physical exertion (such as sport), symptoms (heartbeat) become more and more common with increasing age. The heart is restricted in its place and cannot produce the full, increased pumping capacity. The lung volume can also be restricted, which can lead to shortness of breath and difficulty breathing.

Pain

Pain can certainly arise with a funnel breast. The bones of the chest, i.e. the sternum and ribs, as well as the spine and shoulders can be affected by the misalignment.

For example, you may experience pain when you breathe deeply. Pain when moving the upper body is also possible. If the person concerned has poor posture overall, pain can also arise when sitting or lying down for long periods of time.

The pain caused by incorrect posture, tension and misalignment should definitely be treated with posture exercises and muscle building training as well as physiotherapy.

Back pain

Back pain can occur with a funnel chest and is not uncommon. The thoracic spine is connected to the sternum via the ribs, where the depression and the actual malformation are located. The misalignment can cause pain in the bones of the spine.
In addition, so-called kyphosis (backward curvature of the spine) often occurs in the thoracic spine, which can lead to tension in the muscles and pain in the back. To counteract this, muscle building exercises should also be carried out regularly.

Which doctor treats a funnel breast?

The diagnosis of whether it is a funnel breast, how pronounced it is and to what extent the health of those affected is restricted is largely made by the orthopedic surgeon. He can also prescribe any necessary physiotherapy or physiotherapy.

In thoracic surgery, patients should present themselves if a funnel chest correction is planned.
There are special clinics for children with a department for children's thoracic surgery.

diagnosis

The Diagnosis of the funnel breast is a so-called eye diagnosis.
You can usually see the patient's "problem" from the outside. To find out how severely he and his physical functions are restricted as a result, a CT be performed. This layered image of the body shows exactly which organs are being displaced. Particular attention is paid to the heart and its functionality.

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

• Lumedis - orthopedic surgeons
  Kaiserstrasse 14
  60311 Frankfurt am Main

You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.

therapy

At Freedom from complaints and before 14.-16. age exists in the funnel breast very rarely a need for action. Regular follow-up checks, posture training and physiotherapy are priority in childhood. Through targeted exercises, the funnel-related Corrected bad posture but not the funnel breast itself. Training the back muscles can help to limit or prevent consequential damage from the funnel breast. In addition, the Incorrect loading of the intervertebral discs counteracted with back stabilizing exercises. The use of a suction cup can also alleviate the discomfort of the funnel chest.

Surgical correction of the funnel breast is included functional impairments indicated by the malformation, especially if that heart or the lung be damaged by the funnel breast. In some cases it can Displaced heart and thus in the Pump performance impaired become.
However, it often happens too mental impairments through the cosmetic problems that come with the funnel breast, with one impaired self-esteem up to shameful lack of contact. In some cases, surgery for cosmetic correction can also be performed. Often be exclusively psychological-cosmetic reasons For the operation, however, not accepted by German health insurances and the treatment costs may not be covered.

Even if the Spine With Back pain as a result, a surgical procedure can follow.

Can exercises against a funnel chest help?

Breathing exercises, muscle building and posture training are very important with a funnel chest, no matter how strong it is. A funnel chest can cause breathing problems such as shortness of breath, which can be improved by breathing training and posture training.

If you have a light funnel chest, muscle building exercises can cause the funnel chest to narrow. Raising a funnel chest purely through exercises, however, takes time. In the best case, you can find out from a physiotherapist which exercises are most suitable.

Implant in a funnel breast

In the case of a slightly pronounced funnel chest that does not affect the health of those affected, the sunken chest wall can be covered by an implant. However, this requires an operation.

The specially made implant that fits exactly into the sunken area in the chest wall is placed under the muscles using an approx. 7 cm incision. In addition to an implant, muscles or fat can also be transplanted.

Since this method is only used for cosmetically problematic funnel breasts, this treatment method is usually not paid for by the health insurers, but by those affected themselves.

Suction cup

A relatively new (since 2002) method of treating a funnel breast is the suction cup. Various studies are currently underway to investigate the effectiveness of the suction cup.
With the help of a vacuum created by the suction cup, the chest should be slowly raised. To do this, the suction bell has to be used for one hour a day, over a period of two to three years. The hope of the users and the manufacturing company is that the suction cup will make surgical treatment of the funnel breast superfluous in the future.
So far, improvement of funnel-related postural errors such as hunched back or posture blockages, tightness, heartburn or funnel-related hiccups through regular use of the suction cup have been described.
The advantage of the application is that the suction cup can also be used in everyday life and at home and that the presence of a doctor is not absolutely necessary. The treatment can cause mild pain, especially in the initial stages, but it cannot be compared to the pain after an operation.

According to the reports so far, not only children, but also middle-aged adults benefit from the suction cup. Long-term results are still pending.

Read more about this under: Treat the funnel breast with a suction cup

Operation of the funnel breast

In rare cases, functional impairments of the lung function or the heart function are present due to the funnel breast. Then an operation of the funnel breast is indicated in every case. In most cases, the funnel breast is corrected surgically for cosmetic reasons. Basically, the aim of the operation is to mechanically lift the sternum and fix it in the corrected position.

The operation of a funnel breast usually takes place under general anesthesia and with epidural catheter anesthesia (for postoperative pain relief). Mainly a minimally invasive procedure ("keyhole technique") is chosen, for which only small skin incisions are required. To correct the funnel chest, a U-shaped bracket is pushed under the funnel base of the breastbone. In the following, the sternum is lifted forwards by turning the bracket 180 °.
In rare cases, an open operation is performed: The cartilage connections between the sternum and ribs are severed and the sternum is then fixed in the correct position using splints. A plastic correction of the funnel breast with silicone implants can also be carried out. The funnel is not lifted, but only balanced by a silicone implant under the skin.

Before the operation, an X-ray is taken of the chest, which measures the minimum distance between the back of the sternum and the front edge of the vertebral bodies. Wound healing disorders, the development of a pneumothorax (air enters the gap in the lungs and breathing is impeded), infections of the wounds or the foreign material introduced, as well as severe pain after the operation are risks in the operation of the funnel chest. Rotational movements of the upper body against the trunk must be avoided for about three months after the operation, and intensive physiotherapy is required. The rod is removed no earlier than three years after the operation and again under general anesthesia.

further information at: Funnel breast OP

Minimally invasive surgical procedure

Minimally invasive surgery only requires small incisions in the skin, which has cosmetic advantages.
With the help of a thoraxoscopy, U-shaped brackets adjusted under the sternum (lat. sternum) pushed.
The sternum is lifted forwards / outwards by turning the bracket 180 °.

Open surgery

There are several variants of open funnel breast surgery.
In all variants, the cartilage connection between the ribs and the breastbone is first cut and the breastbone is lifted upwards.
In one procedure, after the cartilage has been loosened, a steel splint is pushed under the base of the funnel, which fixes the breastbone that has been lifted forwards.

Another option is the procedure that introduces special funnel chest splints into the ribs and thus fixes the sternum.
The sternum can also be fixed by muscle sutures alone.

There is also a cosmetic solution that can only be used for cosmetic corrections but not for functional complaints.
A silicone implant pushed under the skin can balance the funnel breast.

Long-term prognoses have shown that the minimally invasive procedure has an equally good functional and better cosmetic result, so that the minimally invasive procedure is preferred in the clinics.

OP preparation

A few preparations need to be made before the operation.
This includes:

• a blood draw
• a resting EKG
• a lung function analysis
• an X-ray of the chest from the front and side.

Here, the smallest distance between the rear surface of the sternum and the front edge of the vertebral body is measured.

In addition, a

• Exercise ECG
• an echocardiography
• an allergy test
  or
• a CT can be done.

This depends on the respective symptoms.

Risks

As with other operations, there are certain risks involved in funnel breast surgery.

The following symptoms can occur after the surgical procedure:

• severe pain,
• Wound healing disorders,
• Wound infections,
• Bleeding.

The individual symptoms only need to be recognized early on so that one can act accordingly.

Aftercare

An important point of funnel breast surgery is aftercare.
Appropriate pain therapy must be guaranteed.
Immediately after the operation, another x-ray should be taken in two planes, front and side. The correct position of the rods and the corrected funnel chest angle are assessed.

The sutures can be removed on the 10th day after the surgery, provided the sutures have healed well.
The patient can leave the hospital on the day on which the sutures are pulled if the symptoms are free or have fewer symptoms.

An outpatient x-ray check should be carried out two weeks after discharge, 4 weeks after discharge and then every three months.
The patient must also be careful not to perform any twisting movements for the next three months.

After the first four weeks after the operation, the physical strain can slowly build up. Contact sports such as soccer, basketball or judo are forbidden during the time when foreign material is in the chest.

The rods or brackets can be removed no earlier than three years after the funnel breast surgery. The removal is again carried out under general anesthesia.

The old seams are opened again and the rod or bracket loosened and removed with a twisting movement.

prophylaxis

A funnel breast cannot be prevented because it is innate and can develop over the years.

forecast

After such a Funnel breast OP the person concerned should take it easy first. But even everyday things have to be restricted in the first time after the operation. Particularly when sleeping (no stomach sleep in the first 7 weeks) and also when lifting, caution is advised.

After the operation, the patient should be in physiotherapy treatment embark on the Musculature to strengthen and adapt to their new circumstances.

Does a funnel breast affect life expectancy?

The funnel breast as such is a common malformation and also occurs in families. In most cases, however, it is not very pronounced and does not limit the health of those affected, but rather represents a cosmetic problem.
Nevertheless, breathing exercises and posture training should be done at the first signs of a funnel chest, as poor posture can worsen the funnel chest as it grows. A slightly pronounced funnel breast does not affect life expectancy.

However, if it is accompanied by another disease, such as Marfan syndrome, life expectancy is reduced. However, this is not due to the funnel breast itself, but to the changes in the heart and blood vessels that are common in Marfan's syndrome.