Pectus can present with physical or psychosocial symptoms or none at all. So which physician should you see if you have questions about Pectus?
If it's your first time, start with a primary care physician, whether that's a pediatrician or a general internal or family medicine physician. Even if you know you have Pectus, and you think you're ready to talk to a specialist, it's very important to see a primary care physician first. Pectus is commonly an isolated condition, but it can be associated with many other syndromes or diseases, such as Marfan's, Poland, Ehlers-Danlos, and others. These primary care physicians are well-suited to screen for these other conditions. Your primary care physician will also act as your advocate and team leader if you end up seeing other specialists and need help synthesizing together all the information.
If your primary care physician has a concern for another co-existing condition in addition to your Pectus, they may send you to specialists including a geneticist.
Next, if you're Pectus is moderate to severe, your primary care physician should send you to a cardiologist and pulmonologist. Standard assessments in the evaluation of Pectus include echocardiogram and pulmonary function tests. If you've already seen a primary care physician, and you're insurance lets you see specialists without referrals, this would be the next step.
Don't forget about possible psychosocial issues. If you additionally feel that psychosocial symptoms related to your Pectus (e.g., poor body image, low self-esteem, depression, etc.) play a role in affecting your quality of life, it is especially important to be seen by a psychiatrist or similar psychologist. This is an often overlooked aspect of Pectus but can be an important factor in the decision making process regarding treatment.
Finally, if you're Pectus is moderate to severe, and there are concerning symptoms, regardless of your age, and you would be willing to learn more about surgical treatment, see a surgeon. Most commonly this will be a pediatric surgeon, even if you're an adult. However, you may consider seeing an orthopedic surgeon or a plastic surgeon. The surgeon can teach you about your options for treatment but they will also want to see results from physiological assessments (e.g., cardiologist and pulmonologist) to help you make an informed decision.
Not all patients will need treatment, but currently, the most effective treatment for pectus excavatum is surgery. There are no other proven safe and effective treatments. Extremely minor cases may be cosmetically improved with exercise. However, it is important to note that exercise will only change the shape and size of muscle, whereas pectus deformities occur because of abnormal bone and cartilage.
The most common surgical approach for pectus excavatum is called the Nuss Procedure. This minimally invasive surgery usually requires two incisions, one on each side of the chest, for insertion of a metal bar. The metal bar is bent to the desired shape of the chest. The bar forces the chest outward to immediately correct the pectus deformity. The bar remains implanted usually for about three years and then a minor outpatient surgery is required to have it removed. Sometimes more than one bar may be required and two bars is the most common.
The Vaccum Bell is not yet proven as an effective treatment for pectus excavatum. Studies have shown that the device is capable of lifting the chest but long-term studies are needed to establish whether the treatment leads to permanent reversal of the deformity.
For mild to moderate pectus carinatum, bracing techniques are effective. A brace is used to apply pressure on the chest to slowly reduce the chest deformity. In severe cases, surgery may be necessary.