Minimally Invasive Technique for Treating Common Chest Wall Abnormality Helps Give Young Adult Confidence

Philadelphia, PA, August 13, 2015 --( It’s hard to come across a 16 year old girl who doesn’t have at least one insecurity.

“I didn’t really notice until I was a teenager that I had a pretty big indent in my chest,” says Erica Yi, of Huntington Valley, Pa. “And it made me really self-conscious – I always tried to keep it covered and never wanted to be in a bathing suit.”

Erica was 16 at the time and her general physician had also noticed the indent. She recommended that Erica visit St. Christopher’s Hospital for Children to be evaluated.

“When Erica came to see me, it was clear that she was suffering from a significant case of pectus excavatum,” says Rajeev Prasad, MD, Pediatric Surgeon and Director of the Minimally Invasive Surgery Center at St. Christopher’s Hospital for Children. “It’s a common abnormality of the anterior wall of the chest, in which the sternum and several adjacent ribs grow abnormally. This produces a ‘caved-in’ look to the chest. Alternatively, some patients develop pectus carinatum, where the chest protrudes abnormally.”

Dr. Prasad adds that pectus abnormalities present at around the time of birth in some patients or around the onset of puberty in others. He sees about 25 patients a year for both conditions and comments that almost all of the patients he sees express that they have some level of embarrassment over their appearance.

According to Dr. Prasad, the previously common method for correcting severe cases of pectus excavatum and carinatum required a large incision on the front of the chest and removal of portions of multiple ribs to correct the abnormal position of the sternum. He says that this older technique takes several hours to complete and results in a significant scar on the front of the chest.

For patients with pectus excavatum, Dr. Prasad has now mastered a minimally invasive technique called the Nuss Procedure, which he recommends to patients like Erica. In this operation, a curved metal bar, custom shaped for each patient, is placed under the sternum through small incisions on the side of the chest using a long telescope to guide placement.

Dr. Prasad says that by using this minimally invasive approach, patients typically benefit from:

A much shorter time under anesthesia than the older operation

A short hospital stay of about 3-4 days and a faster recovery time than the traditional method

· Return to movement or activity soon after surgery
· Pain that is well-controlled using an epidural catheter initially followed by oral medications at discharge
· Less scarring due to smaller incisions that are hidden on the side of the chest
· Correction of the pectus abnormality

“Patients require a second even less invasive operation to remove the implanted bar 2-3 years later,” says Dr. Prasad. “For pectus carinatum, surgery is rarely performed nowadays as complete correction can be attained using a chest brace, again avoiding both a big operation as well as an unsightly scar.”

Erica’s first surgery took place when she was 16 years old; her second at age 19.

“I was terrified before my first surgery,” says Erica. “And it took some getting used to, but after only a few weeks, I hardly noticed that the bar was in my chest. And I immediately noticed less of indent after surgery.”

For Erica, the recent procedure for bar removal was just a small step but also the last in this entire process.

“I’m happy that I went through the procedure in the first place,” says Erica. “I’m more confident now and the scars from the incisions are so small that I can hardly see them. Plus, I learned so much about the entire process, which is cool to tell people about.”

So cool, in fact, that Erica has decided to pursue a career in medicine. She is currently a sophomore at the University of Pittsburgh.

As an expert in Pediatric Minimally Invasive Surgery, Dr. Prasad has performed the Nuss Procedure on nearly 100 patients. To learn more about minimally invasive surgery or to make an appointment with Dr. Prasad at St. Christopher’s Hospital for Children in Philadelphia or one its convenient satellite locations in Pennsylvania or New Jersey, call 1-888-CHRISKIDS (1-888-247-4754) or visit
St. Christopher's Hospital for Children
Kelsey Jacobsen