Surgery for chest abnormality improves body image

NEW YORK (Reuters Health) - The surgical repair of a congenital deformity of the chest called pectus excavatum, or funnel chest, can dramatically improve a child's body image as well as physical and psychosocial functioning, according to a report in the current issue of Pediatrics.

"These results should prompt physicians to consider the physiologic and psychological implications of pectus excavatum just as they would any other physical deformity known to have such consequences," Dr. Robert E. Kelly, from Eastern Virginia Medical School, Norfolk, and colleagues conclude.

Pectus excavatum is an abnormal formation of the rib cage that gives the chest a caved-in or sunken appearance. It is caused by overgrowth of the connective tissue that connects the ribs to the breastbone, which makes the sternum curve inward. This causes a depression in the center of the chest that can be quite deep.

Using the Pectus Excavatum Evaluation Questionnaire, the research team assessed the thoughts about body image and functioning of 264 patients, ranging in age from 8 to 21 years, who underwent surgical repair. Their parents also participated. A 1-year follow-up survey after the surgery was completed by 247 patients and 274 parents.

The responses were rated on a scale of 1 to 4, with higher scores indicating a less desirable experience.

Overall, 97 percent of patients thought that the surgery improved the appearance of their chest, the report indicates. Surgery was also associated with a reduction in feelings of social self-consciousness and an improved body image.

Specifically, the patients' average body image score improved from 2.30 to 1.40 and the physical difficulty score from 2.11 to 1.37.

The results of the parents' survey also indicated improvements in their child's emotional difficulties (scores improved from 1.81 to 1.24), social self-consciousness (2.86 to 1.33), and physical difficulties (2.14 to 1.32).

Kelly and colleagues note that pectus excavatum is often dismissed as "only cosmetic," but they suggest that the condition "is not trivial in its effects on the life of the child."

SOURCE: Pediatrics, December 2008.