Al Tarshihi Thoracic Clinic
Dr. Mohammad Ibrahim Al Tarshihi is a consultant thoracic surgeon with Jordanian Board certification and thoracic and thoracoscopic fellowship training in Germa…
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Thorathic wall abnormalities repair Doctors in Jordan
اصلاح تشوهات جدار الصدر
Chest wall deformity repair covers a group of procedures that correct the shape of the breastbone and the cartilage attached to it. The two commonest patterns are pectus excavatum, where the sternum is sunken inwards and the chest looks hollow, and pectus carinatum, sometimes called pigeon chest, where the sternum projects forwards. Less common variants include partial absence of a muscle or cartilage on one side. Assessment starts with clinical examination, age and stage of growth, because timing changes every option. A CT scan measures the depth of the depression and its relationship to the heart and lungs, and an ECG, echocardiogram and breathing tests are added when there is exertional breathlessness, palpitations or reduced tolerance. Some cases genuinely compress the heart and lungs; in others the main concern is chest appearance and its psychological effect on an adolescent. Both are legitimate reasons to seek treatment, but eligibility is decided by clinical assessment and measurements, not by a photograph. Not all options are surgical. A custom external brace is effective for pectus carinatum during the growth years, but it demands commitment to daily wearing hours over months. Moderate and severe pectus excavatum is corrected surgically: either by passing a curved metal bar behind the sternum through two small side incisions to lift it, with the bar usually removed after two to three years, or by reshaping the cartilages through an anterior incision in selected cases. The commonest complaint after surgery is pain during the first two weeks, managed with a combined analgesia plan that may include an epidural catheter in hospital, together with breathing and posture exercises and avoidance of contact sports for several months. The limits are important. **No exercise programme, muscle brace or home suction device corrects a genuinely sunken sternum** — exercise improves muscle, posture and confidence but does not change the shape of bone and cartilage. An external brace does not work once growth has finished, and it is not used for excavatum the way it is used for carinatum. Surgery improves appearance substantially but does not deliver a perfectly symmetrical chest, and it leaves incision scars. Many mild cases need observation rather than an operation, and not every breathless patient with a chest deformity is breathless because of it — asthma, anaemia and simple deconditioning are looked for too.
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Procedure steps
- 1
Examination, measurement and growth stage
The type, severity and symmetry of the deformity are documented, height, weight and pubertal stage are recorded, and the depth of the depression is measured on CT. Timing is central: bracing works during growth, while bar surgery is usually preferred in adolescence or later depending on the case.
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Assessing the effect on heart and lungs
When there is exertional breathlessness, palpitations or chest pain, breathing tests, an ECG and an echocardiogram are requested. The aim is to establish whether the depression compresses the heart or limits lung expansion, or whether something else entirely is responsible and needs its own treatment.
- 3
Choosing between bracing and surgery
Pectus carinatum in someone still growing is usually treated with a custom external brace worn for set daily hours with regular review. Moderate and severe pectus excavatum is offered surgical repair, and expected results, risks and scarring are explained to you before you consent.
- 4
Surgery and bar placement
Under general anaesthesia a curved metal bar is passed behind the sternum through two lateral incisions, with camera guidance to protect the heart, then fixed in place so it lifts the sternum towards a more normal contour. In some cases the cartilages are reshaped through an anterior incision instead.
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Recovery and later bar removal
Pain is greatest in the first two weeks and is managed with a regular analgesia plan, alongside breathing and posture exercises and log-rolling out of bed rather than pushing up. Contact sports are deferred for several months, and the bar is removed in a smaller operation, usually after two to three years.
Before the procedure
Tell the team your age and growth stage, all your medicines and supplements, any drug allergy or previous problem with anaesthesia, and any heart or lung disease, clotting disorder or family history of connective tissue disease. **Do not stop antiplatelet or anticoagulant medication on your own; when to pause it before surgery is a joint decision between the surgeon and your cardiologist, and the same applies even before dental procedures.** If you smoke, stop several weeks beforehand. Begin breathing and posture exercises before the operation so they are easier afterwards. Follow the fasting instructions, bring imaging and lung function reports, and arrange enough time away from school or work, a hospital stay of several days and an escort. Discuss expectations frankly before consenting: ask what will change in appearance and what will not. If bracing is the plan, follow the daily wearing hours precisely, because the result depends on that more than on anything else.
After the procedure
Take pain relief on a regular schedule for the first two weeks rather than waiting for pain to build, breathe deeply, use the incentive spirometer and walk daily. Get out of bed by rolling onto your side rather than pushing through your chest, sleep on your back at first, and avoid twisting, heavy lifting, hanging from bars and contact sports for the period your surgeon specifies. **Go to the emergency department immediately for sudden severe pain, a sensation of movement or clicking of the bar, a sudden change in chest shape — the bar may have shifted — or for breathlessness, sharp chest pain, high fever with redness or pus at the wound, or new numbness and weakness in an arm.** Tell any doctor or imaging technician that you have a metal bar in your chest before any scan or procedure. Keep your follow-up appointments even after the pain has completely gone, because the timing of bar removal is decided by your surgeon, not by how well you feel.
Expected duration
Surgery usually takes one to three hours depending on the technique, with a hospital stay of about three to six days, return to school or desk work within two to four weeks, contact sports after several months, and bar removal usually after two to three years.
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