Procedure Expands Teen’s Chest and Confidence

Today, Brandon Gottlieb considers his experience with pectus excavatum, or “sunken chest,” a positive one. Looking back, he sees how it built character and confidence.

“At the time, I was in middle school when self-consciousness is at its peak. Realizing I was different from my peers was a head tilter,” says the 18-year-old. “I didn’t like taking off my shirt in public, and I was bullied by some of my so-called friends, but in the end it was good for me.”

Pectus excavatum is a depression in the chest wall that affects approximately 1 in 400 children, and it is much more common in boys. A child can be born with pectus excavatum or develop it during a growth spurt in puberty.

“Often, when I first meet preteens with a chest wall abnormality, they come in very socially withdrawn, but once we correct it, they are like a new person. They blossom into who they are meant to be. It really seems like a world of change,” says Stephanie Chao, MD, pediatric general surgeon and program director of the Chest Wall Program at Lucile Packard Children’s Hospital Stanford, the core of Stanford Medicine Children’s Health.

Gottlieb, who is from Los Altos, was 11 years old when he came to Packard Children’s Hospital’s Chest Wall Program, a multidisciplinary program known for its top-notch doctors, radiation-free imaging, and innovative pain control techniques. It’s one of the larger-volume chest wall programs in the nation.

“I would definitely recommend Packard Children’s Chest Wall Program. I’ve heard stories from other kids who went elsewhere who didn’t get the best results or they had a lot of pain. My experience was nothing like that,” Gottlieb says.

Gottlieb is very athletic, and he played several sports growing up, with basketball being his favorite. His sunken chest was hardly noticeable when he was a child, but when he became a preteen and grew rapidly, the indent got deeper and the flare in his ribs became more visible.

Pectus excavatum can be mild to severe. Some children with severe pectus excavatum become short of breath while playing a sport, or experience discomfort or pain from the pressure on the heart and lungs.

“Pectus excavatum can cause discomfort and children feel like they can’t take a deep breath. My patients often tell me they feel like they cannot keep up with their peers in sports. Psychologically, it does the same thing. When fixed, it creates more space to breath and more space for the heart—and more space for them to gain confidence,” Dr. Chao says.

Gottlieb’s was somewhat severe, but he didn’t notice physical symptoms. Since his family didn’t want him to undergo surgery right away, Dr. Chao suggested that he try the vacuum bell, an option available at only a few children’s hospitals nationwide.

“There’s no one-size-fits-all treatment plan. As a surgeon, it’s not my job to convince families to do surgery, it’s to find what works best for them,” she adds.

The vacuum bell, a nonsurgical option

The vacuum bell is a circular rubber disc that’s placed on the center of the child’s chest over the indent. It’s pumped up to create a vacuum, which raises the sternum over time. It’s typically worn about four hours a day for about a year. It’s most effective for mild to moderate cases.

“Even though it’s only successful about 25% to 30% of the time, some patients and families want to try everything they can before surgery,” Dr. Chao says. “They don’t have a lot to lose, and even if it doesn’t work, it helps condition the chest for surgery later on.”

Gottlieb was great about wearing the vacuum bell, even setting his alarm at 4 a.m. to get in a few required hours of wear before school. Yet for him it didn’t produce the outcome he desired.

Nuss procedure does the trick

When Gottlieb turned 13, he underwent surgery during the summer before his freshman year in high school. He decided it was worth it to miss a little of his basketball preseason in the fall.

The Nuss procedure is the most common surgery for pectus excavatum. It’s a minimally invasive surgery that requires a pediatric surgeon to make two small incisions on each side of the chest. A metal support bar is then inserted underneath the sternum on each side, and it stays in place for two to four years. Over time, the depression in the chest disappears.

“The surgery was a complete success. My hospital stay was supposed to be five nights, but I went home after two nights,” Gottlieb says. “I love Dr. Chao. She’s great with preteens. She treated me like an adult by giving me the real story, and at the same time she was very sweet and comforting.”

He didn’t have much pain with the surgery, and after a week or two, his pain mostly subsided, and fairly quickly became nonexistent. He had an ESP block, which provides continuous pain relief after surgery and speeds up recovery.

“It’s important to us to limit the use of opioids for pain control. Most kids only take them for two to three days,” Dr. Chao says. “We have innovative pain control techniques like cryoablation, which freezes the nerves along the ribs on both sides of the chest and decreases overall sensation to the chest wall.”

Back to basketball and a full life

Within a month, Gottlieb was asking Dr. Chao if he could go back to basketball. At one month, she allows gentle aerobics, but she wants kids to wait three months before returning to their sports to ensure complete healing.

“I work with patients over several years, and I really get to watch them grow up. I remember Brandon maturing from a cute kid into a confident young man.”

Gottlieb had the bars removed in summer 2021, before his freshman year in college at the University of Wisconsin-Madison. Dr. Chao reflects that it often goes like this—she takes out the bars and says goodbye to her patients at the same time as their parents, who are sending them off to college. Gottlieb is happy with how his chest looks, and he’s so glad that he went ahead with the surgery.

“I want kids with sunken chest to know that it’s totally worth it to have the surgery. I was super-worried about missing out on my sport for a few months, but it really paid off in the end,” he says.