This is a great question ! However, one needs more details to give an adequate answer. It is important to know what kind of surgery is performed ? Are you interested in the interval between surgery and start of exercises ? Do you mean active sports training or just exercises in the frame of a kinesitherapeutic program ?

Surgery for pectus excavatum is a serious intervention loaded with some complications incl. injury to pleura and lungs. There is a period of at least 6 months before the sternum heals after the classic Ravitch operation. If this is the procedure applied in your patients, then active training or intensive exercises may start gradually after at least 6 months. You must keep in mind that some surgical techniques for correction of pectus excavatum use plates or K-wires to fix the corrected position until the anterior chest wall heals reliably. Some migration ( sometimes dangerous !) of these osteosynthetic devices is possible which makes the kinesitherapy and training a very delicate matter.

It have gone some time since surgery, I think it is Nuss (i am not so sure about the name of the surgery, but he has a steel bar behind sternum). This boy have very poor posture, he (an older teenager) came with his mother to seek help, got what I understand very little physiotherapy after surgery. It is not easy to motivate him, for the moment better posture and just be more active and of course feel better is the goal.

Dear Anna,

Unfortunately, teenagers with funnel or pigeon chest are difficult patients because of the existing psycological or characteropathic problems. It is difficult to motivate them to perform systematic physiotherapy for bettering of posture, strengthening of back and thorax muscles, respiratory gymnastics, etc. An adequate approach is needed, so that they get interested in training and find some fun in it. In my practice I recommend swimming. Some of my patients have been so attracted and so fascinated by swimming that they started active and even competitive swimming.

Good

I will try to motivate him to swim, that is a good suggestion, I hope he like water.

Dear Anna

The deformity pectus excavatum can be treated in most cases by conservative methods ( physiotherapy and or theses) with good results. In my opinion the surgical treatment is an excess ion and when necessary can get a better correction deformity but the postoperative scar could bring more problems with respect to cosmetic appearance. It is necessary to talk with the patient and the family explaining the positives and negatives points of surgical treatment and then decide together with the patient and the family

I met him after surgery, so that is were it start for me.

But I am rather sure that he needed this surgery it is not easy do get this surgery done, many hospitals do not perform hit at all.

Dear Nelson, I am sorry but I have to disagree with you as far as funnel chest correction is concerned. Unfortunately, conservative treatment (orthoses, exercises, respiratory gymnastics, etc.) may only contribute to improving the general status but not the local deformity. Usually, the pars anterior of diaphragma is too short as a congenital anomaly at birth and this is a sort of rigid rein that pulls the sternum inwards. Especially, in the prepubertal phase of growth the deformity gets deeper and deeper. There are different grades of pectus excavatum. Of course the light forms should not be treated surgically because they represent just a cosmetic defect. Unfortunately, there are severe grades and forms which restrict the respiratory function, displace the heart and cause severe functional problems (i.e. Marfan syndrome). These cases are indicated for surgical correction. The results are good, although sometimes serious complications happen. We use for many years the classic Ravitch procedure in combination with transverse plates to keep the correction untill the healing of the sternum occurs (usually 1 year after the operation). After that we remove the plates.

Dear Panayot

i agree with surgical treatment if the patient has severe grade which restrict the respiratory function , displace the heart and cause functional problems. In my experience there are few cases with cardio pulmonary complications being much more frequent complaints of anti aesthetic deformity

From what I heard from surgeons the ones that get surgery are in need for it

That is right, Anna. Sometimes, apart from functional disorders, these adolescents have need to overcome a psychological barrier. They stay apart from their classmates, they do not like to take part in sports, they do not like to take off their clothes for swimming, etc. This condition is very severe and represents an other consideration for surgical treatment.