FAQ(Frequently Asked Questions)

All of the surgical or non-surgical treatments performed to correct this condition in people with chest deformities caused by malformations in the bones or cartilages of the ribs or sternum bone forming the rib cage can be collected under the title of chest deformity surgery.

If we detail the patients who are candidates for these treatments, we should have to write almost all of these Pectus Deformities.

1- Funnel Chest (Pectus Excavatum): Also known as Sunken Chest. It is the condition that the sternum bone is collapsed into the rib cage according to where it should be. It is the most common thoracic wall deformity. It causes volume loss in internal organs such as heart, lung, esophagus, stomach. It also causes pressure on these organs. It impairs the diaphragm functions and causes a deterioration in effort tolerance. It is the cause of arrhythmia and palpitations. It causes posture disorders and spine problems such as humpback (kyphosis), Scoliosis, forward facing of the shoulder heads, winging of the scapula. Its psychological effects are named as Mental Deformity in the literature. Funnel Chest is the cause of low self-confidence and anxiety in approximately 80% of patients. It is also a very important problem aesthetically. It causes the patient to feel disabled. 2- Pigeon Chest (Pectus Carinatum): It is the condition that the sternum bone is more out of place than it should be. It causes posture disorders and spine problems such as humpback (kyphosis), Scoliosis, forward facing of the shoulder heads, winging of the scapula. It causes psychological (mental deformity) and aesthetic problems. 3- Pectus Arcuatum: mixed deformity in which pectus excavatum and pectus carinatum are seen together 4- Poland’s Syndrome: Absence of pectoral muscle other than anomalies of ribs, underdevelopment or absence of breast, adherence of hand fingers – syndactyly- and other hand or arm anomalies 5- Sternal Cleft: The situation that the middle of the sternum bone remains open (and sometimes even the fact that the heart is outside, which we call ectopia cordis, may accompany this situation) 6- Rib Flare: Outward protrusion at the ends of the ribs (protruding rib deformity) 7- Thoracic Dystrophies: As a result of the improper development of the ribs, vital organs such as the heart and lungs to underdeveloped. There are basically two subgroups (Asphyxiating Thoracic Dystrophy and Fibrodysplasia Ossificans). The form often seen as “Asphyxiating Thoracic Dystrophy” has 22 different types. The most commonly known is “Jeune Syndrome.” Other well-known ones are Saldino-Noonan Syndrome, Majewski Syndrome, Mainzer-Saldino Syndrome, Beemer-Langer Syndrome, and Ellis-van Creveld Syndrome. 8- One of the dozens of syndromes in which chest deformities are only a component: Achondroplasia, Marfan Syndrome, Osteogenesis imperfecta, Anterior Thoracic Dysplasia, Noonan Syndrome, Ehler Danlos Syndrome, Spinal Muscular Atrophy (SMA), Loey-Dietz Syndrome, Celiac Disease, Charcot-Marie Tooth Disease, Atelosteogenesis Syndromes, Pierre-Robin Syndrome, Sprengel Deformity, Sotos Syndrome, Jarcho-Levin Syndrome, Radial Club Syndrome and Holt Oram Syndrome and etc.

All individuals with these deformities need to be treated, even if the deformity itself has not caused any physiological problems other than aesthetic-psychological anxiety. Moreover, there is no specific age range for treatment. Treatment can be applied to young children from the age of 0. In fact, the earlier the treatment is started, the higher the chance of success of non-surgical treatments. Therefore, patients should consult a doctor as soon as the deformity is noticed by the parents. There is no upper age limit for treatment. We have treated dozens of individuals over the age of 40 (and even over 50 years old) who were afraid of being exposed to the bad effects of pectus deformities in old age and wanted to invest in themselves. In fact, we added the largest series reported on this subject in the world to the scientific literature. You can find this article in the relevant section of our website.

• The benefit seen from the results obtained with corrective treatment is monitored by the type, shape of the deformity, and the depth-to-dislocation ratio. For example, for a rib flare deformity only aesthetic and psychological benefits can be seen, whereas in a thoracic dystrophy this treatment is essential for survival. In the same way, in a very deep pectus excavatum deformity, treatment can completely increase the patient’s quality of life by removing the pressure on the organs that will affect all vital functions of the patient. While after treatment in another patient with same type of deformity (pectus excavatum) with only a very small amount of collapse, physiological benefits can be provided but in this situation there could be no increase in the quality of life that the patient can notice.

  However, the benefits that patients can derive from these treatments can basically be listed as follows:

  1- Restoring the pressure on the heart and lungs and the loss of volume stolen from these organs: The most common symptom of Thorax deformities is decreased effort tolerance. That is, patients are cut quickly during exertion, for example; while swimming or climbing stairs, they experience shortness of breath and palpitations and have to take a break from the effort at that moment. Moreover, this situation, which is detected only during exertion in youth, may cause limitation for every movement in old age. Here, patients invest in their health, both in their youth and mainly in their old age, as a treatment.

  Moreover, cardiac pressure does not only cause a decrease in effort tolerance due to volume loss. There are also problems related to direct printing. The first of these is the complaint of palpitation of the patients. Pressure on the heart can cause arrhythmias in the heart. While this may sometimes cause changes that can be seen on electrocardiography (ECG), it can sometimes be so minimal that it cannot be detected. However, it usually causes arrhythmias and patients feel it as palpitations. In addition, although it does not cause any problems in youth, no one knows whether the pressure on the heart will cause problems in the heart (heart attacks, etc.) after the age of 50. In cases where the rib cage is small, such as with Jeune Syndrome, these organs also remain small, and as children grow and develop, these organs become unable to meet their needs. Therefore, these treatments are beneficial enough to be essential in these patients.

   

  2- Elimination of Pressure on the Stomach and Esophagus: I want to draw your attention to one issue. Almost all of the individuals with chest deformity that you see around you or on the internet are weak. Because the pressure and loss of volume on the esophagus and stomach cause them to be individuals who feel full and get hungry quickly. This leads to malnutrition in childhood and consequent growth and development retardation.

  In addition, the pressure on these organs causes excessive vomiting in infancy and digestive system problems such as gastroesophageal reflux (GERD) and gastritis in childhood and adulthood. With pectus treatment, all these are removed.

   

  3- Bringing the diaphragm functions to the patient by bringing the diaphragm muscle to the correct position: It has been shown in the literature that pectus patients have poor sleep quality. In the long run, this can lead to deterioration of the immune system, chronic fatigue, failure in academic success and other vital functions, and various psychological problems. In addition, it can cause adrenaline discharge and, accordingly, heart attacks after the age of 50. All these conditions are mostly attributed to the deterioration of the diaphragm function together with other organ compressions.

  4- Elimination of occult anemia, which cannot be detected normally in the body, but is usually present in pectus patients: After some Nuss surgeries, although we have never bled during the surgery, we can observe a decrease of up to 7-8 points in the blood hemoglobin values of the patients. After experiencing this in a large number of patients, I investigated why. Then I found the hypothesis that explains the solution. The heart volume was small because the heart was under pressure before the surgery. In an instant, we removed this pressure and allowed the heart to return to its normal volume. In the meantime, the filling of the newly increased volume of the heart is achieved by drawing the edema fluid in the body tissues into the blood vessels and heart. In the meantime, the existing blood is also diluted. For this reason, the patient’s blood value seems to have decreased, but in fact it was already low. After this process, since the body perceives the blood value as decreased, it sends the order of blood production to the bone marrow and a rapid blood production process begins in the body. In about 3 months, blood values rise again. However, the elevated blood value this time is the blood value in the patient that is actually in good condition, as opposed to the illusory value before the surgery. This is the reason why children’s skin colors, which appear paler before the operation, take on a more vivid and light-colored appearance after the 3rd month of the operation.

  5- Relieving Pressure on Great Vessels: The depressions in the sternum, especially in the upper part of the bone, are of great importance to me. Because this area is the starting point of the great vessels (such as the Aorta, Vena cava) coming in or out of the heart. The pressure on this point can narrow these vessels and cause a decrease in blood supply to the whole body, especially to the brain. If we do a mental gymnastics, low blood flow to the brain can lead to problems such as early dementia in the future, or a decrease in school success in childhood. By adapting this mental gymnastics to each organ, you can think for yourself what kind of problems a low blood flow can cause.

  6- Elimination of posture disorders and spine problems: We always talk about the fact that chest deformities cause an inconsistent posture problem such as hunchback (kyphosis), looking forward at the shoulders, and winging of the scapulae in almost all patients. In addition, 25% of the patients have scoliosis, which we call curvature of the spine to the right or left. All these posture and spine problems can lead to various problems (such as body pain, spinal hernia) in the future. Complete recovery with pectus treatment has been reported in all scoliosis cases below 15 degrees. Moreover, if pectus deformity is treated at an early age without surgery, these problems will be prevented before they occur.

  7- Aesthetic and Psychological Benefits: Various psychological problems such as lack of self-confidence and anxiety were found in 80% of pectus patients. Psychiatrists have named this condition “Mental Deformity” in the literature. I have witnessed some very dramatic situations. I have seen individuals who have never been in the sea or pool in their life, people who have never gone out in windy weather because they think the wind will stick their t-shirts on their body and show their deformity, people who have never taken off their clothes while having sex with their partner, and people who have planned to give up their marriage plans after telling their partner about this problem, etc. This is never an arbitrary aesthetic concern like filling or botox. It is the necessity of eliminating a sense of disability.

   

  However, these individuals get rid of this problem completely, although they do not receive any extra psychological treatment only 6 months after the operation. Let’s not just think of it as surgery; due to child’s pectus deformity, he/she may be “peer bullied” by other children. Let’s not forget that children are cruel to each other. Here, a deformity that can only be corrected with a vacuum bell therapy in the pre-school period will ensure that the child never encounters such a psychological trauma when he starts school.This is not a cure for psychological trauma, but prevention before it occurs. So it will be a kind of preventive medicine.

First of all, I should point out that the answer to this question may vary depending on the surgery performed on the patient and various factors in the patient himself/herself.

If we start to explain with the Nuss operation process, an average of 3 days of hospitalization is required after the operation, and we want him/her to restrict some arm movements for 1 month after the operation in order to prevent the displacement of the bars in the chest. Patients can return to their normal lives 1 month after the operation. They can also start sports after 3 months. Starting from the 3rd month of the surgery, we recommend that patients avoid contact sports and avoid sudden impacts during the 2-3 year period during which the bar removal surgery will be performed. After bar removal surgery, patients can return to their normal lives, including contact sports, from the first day of bar removal surgery.

It is possible to say similar things about the Abramson, Flare Buster, and Sandwich Bar surgeries as I did for the Nuss surgery.

A 3-day hospital stay is required after the custom made 3D silicone implant placement surgeries we perform for Poland’s Syndrome and/or pectus excavatum. In order to prevent edema in the surgery area, it may be necessary to put pressure on that area by wrapping an elastic bandage on the rib cage for about 20 days. Afterwards, the patient can return to his/her daily life and there is no need for more surgery or anything else throughout life.

In Rib Flare corrective surgery, only a one-day stay is usually sufficient.

In other open surgeries (Ravitch Procedure, Onen Procedure, Lateral Thoracic Expansion, Dynamic Thoracoplasty and Sternal Cleft Repair), these standard times vary more, but all of them require an average of 3-5 days of hospitalization followed by a full rehabilitation period of approximately 1 month.

First of all, it should not be forgotten that all non-surgical treatments can only be applied to patients aged 17 and under. The answer to this question, like the previous one, may vary depending on factors such as the patient’s age, the shape and type of the deformity, and additional conditions in the patient.

However, if we are to talk about an average, in orthosis treatment for people under the age of 17, if the patient follows the use exactly as we recommend, the pectus carinatum deformity will be completely corrected after 6 weeks.

Vacuum therapy, on the other hand, improves the pectus excavatum deformity in almost all patients under the age of 11 with 100% results within 1 year at the latest, and provides partial benefits depending on the condition of the patient between the ages of 11-17. In this age group, the treatment option is determined according to the expectations of the patient and his family. If their expectation is to get immediate and 100% results, the patient can be operated directly. However, if they want to try the non-surgical treatment option first, we start vacuum bell therapy for the patients. Vacuum treatment gives 75% of its results after 6 months, and 90% after 1 year. As a result of this one-year period, vacuum treatment can be continued for patients in the 11-17 age group if the patient and family are happy with the result. Otherwise, the decision to treat with surgery could be choosen. Combined vacuum and orthosis treatment for pectus arcuatum patients can yield results within a few years. Another group in which non-surgical treatments should be applied patiently are thoracic dystrophy patients. In these two groups of patients, full results can be obtained with non-surgical treatment, and there may be some cases where the child may have benefits in the first period of growth and then become useless. In these cases, the most important advantage would be to delay the child’s surgery as much as possible and protect the child from early surgery. Another advantage would that it makes the surgery easier.

Orthosis or bandage treatment used in rib flare cases in people aged 17 and under gives 100% results within 6 months.

However, I must emphasize again that these percentages and times are average data and may vary depending on many factors in the patient.

This varies depending on whether the patient has open or minimally invasive surgery. Of course, in minimally invasive surgeries, surgery is performed through only a few incisions of 1 or 2 cm, so there is almost no scar left. In open surgeries, the incision size can increase to 7-8 cm.

However, in all our surgeries, regardless of minimally invasive or open surgery, we make incisions in places that are not visible. In women, whenever possible, we make the incisions coincide with the fold under the breast, just like in breast silicone implantation surgery. Even if a large incision will be made for open surgery, these incisions in the area under the breast are almost impossible to see because they are inside a bikini or bra. In cases where this is not possible in women (such as placing a bar in the upper part) or in men’s surgeries, we make the incisions under the armpit. Thus, by covering this area with the arm, no scar is visible. In only open surgeries in men, 7-8 cm incisions may be visible on the skin on the sternum bone.

We take utmost care to ensure that these incision scars remain as minimal as possible. Incisions are made with special techniques, respectful of the skin. Suture materials and techniques that will cause the least reaction are preferred for closure. We offer various creams and suggestions to patients in order to ensure that aesthetic sutures leave less scars in the future. In the patient who complies with all these, scarring is observed to be almost zero. Some of our patients hide these scars completely by getting a tattoo over these incision scars.

First of all, you need to contact us through any of the communication channels. After your consultation request, a communication will be established between you and the staff of our clinic. We will find out what your problem is and whether it is within our area of interest. Then, if appropriate, an appointment will be made for a time period that will be convenient for both you and the doctor.

While face-to-face consultation and examination appointments are made for patients who are close to our clinic and can apply, online consultation appointments are made for patients who are far away and cannot come only for evaluation purposes. Details about how online consultation is done are available in the relevant section on our website.

As a result of the relevant consultation, you will be informed by your doctor about your disease, treatment options, treatment costs and many other issues. In the meantime, you can ask all the questions in your mind to him.

The part up to this point is considered the first evaluation. During this consultation, within a short period of time after the consultation, or at any time after the consultation (which may also be long-term), if you decide to have the treatment recommended to you by Dr. Ersöz, the decision stage starts. At the decision stage, you contact us again through communication channels and state that you want to be treated. If more than 1 month has passed since the initial evaluation, a consultation with your doctor will need to be arranged again. In this way, all conditions are discussed in their most current form. If you make a decision within one month after the first evaluation, there is no need for a re-consultation unless there is a change (such as an additional disease that has occurred in your health status) in the circumstances you previously declared in the first evaluation, everything that has been discussed before is valid.

When these current conditions are presented to you and you clearly decide to come to Izmir/Turkey and be treated, the trip phase begins. In this process, first some informations such as how many people you will come to Turkey, passport informations of the people who will come, your special requests, if any, and the appropriate flight time will be taken from you in detail by the clinic staff. Thanks to this information, your hospital or clinic appointment for surgical or non-surgical treatment will be made in correlation with the flight time to Izmir, and relevant hotel reservations and airport pick-up will be planned for you in accordance with your landing time. In addition, the necessary organizations will be made so that the individuals we work with, such as a translator in your native language, a physiotherapist, a psychologist, a dietitian, who will accompany you throughout the entire process, can serve you.

When you land in Izmir and pass through passport control, you will be welcomed at the airport by our clinical staff and the translator, whose informations were previously given to you, and you will be taken directly to Dr. Pectus Clinic by private vehicle. At clinic, your doctor will evaluate you in detail. After that:

1- Patients coming for surgery: You will be taken to the hospital where you will be operated by a private vehicle, accompanied by our clinical staff and a translator. At there, your registration will be made and some tests, such as blood tests and chest x-rays, will be performed by the anesthesiologist to determine your suitability for surgery. After your suitability for surgery is confirmed by the results of these examinations, you will be taken to your hotel by private vehicle by leaving the hospital with our clinical staff and the translator. After settling in your room, you will rest. After resting at your hotel until the morning of the surgery (the surgery is usually planned for the next day), you will be picked up from your hotel by a private vehicle, accompanied by our clinical staff and a translator, and taken to the hospital. At there, you will be taken into surgery after meeting with your doctor again. Your translator will accompany you throughout your hospitalization. After you are discharged from the hospital, you will be taken to your hotel by a private vehicle by our translator and clinical staff. During the post-operative follow-up period, while you are at your hotel, you will be picked up from your hotel and taken to Dr. Pectus Clinic by private vehicle, accompanied by our clinical staff and the translator, at the intervals recommended by your doctor. After, your control finished you will be delivered back to your hotel. When this entire process is completed, you will be picked up from your hotel by a private vehicle, accompanied by our clinical staff and the translator, and left to board the flight back to the airport. You can also continue your controls with Dr. Ersöz via online consultation without coming to Turkey again (until second surgery, if a second surgery is recommended by your doctor, such as bar removal).

2- Patients coming for non-surgical treatments: After your doctor’s evaluation, one or more of the vacuum, orthosis or bandage products in appropriate sizes will be applied depending on your condition, and their use will be described in detail. Afterwards, you will be taken to the radiological imaging center within walking distance of our clinic, accompanied by our translator and clinical staff, and a two-way X-ray of your spine will be taken there. After you return to our clinic with this X-ray, your final evaluation will be made with a physiotherapist and physiotherapy will be planned for you. Then, you will be taken to your hotel by private vehicle, accompanied by our clinical staff and a translator. While you continue to apply your vacuum-orthosis or bandage treatments daily as recommended by your doctor during your stay in Turkey, when it is time for your physiotherapy session in the planned interval, you will be picked up from your hotel and delivered to Dr. Pectus Clinic by our clinical staff and the translator. You will attend a physiotherapy session. When your session is over, you will be returned to your hotel by private vehicle, accompanied by our clinical staff and the translator, to rest. When this entire process is completed, you will be picked up from your hotel by a private vehicle, accompanied by our clinical staff and the translator, and left to board the flight back to the airport. In the next period, in your home country, you will continue your vacuum-orthosis or bandage treatment and the physiotherapy movements you were taught, as you learned in Turkey. You can also continue your controls with Dr. Ersöz via online consultation for every 6 months without coming to Turkey again.

We offer 3 types of non-surgical treatment, 12 types of surgery and 3 types of supportive treatment options on dozens of deformities. Sometimes we can combine them. Naturally, treatments vary widely depending on the service requested, the expectations of the patient and his/her family from the treatment, the materials to be used in the treatment, the choice of hospital, the condition of the deformity and the patient, the length of stay in Turkey and many other factors. The most convenient way is to determine the price during the evaluation with online consultation. Unfortunately, it is impossible to determine a standard price this way.

First of all, if we talk about non-surgical treatments, we can clearly say that these treatments have no side effects other than skin discoloration. These color changes on the skin are completely reversible.

lthough there are classical risks in surgical treatments such as infection, which can occur in every surgery, the most important feared problem of pectus surgeries is the risk of heart injury that can be seen in Nuss surgery. All cases of heart injury reported in the literature occurred in the first 100 surgeries of the operating surgeons. Therefore, since we have experience of 1200 surgeries as of September 2023, I can say that our risk in this regard is quite low.

However, we still have some advantages other than experience to minimize this risk. Apart from factors depending on the person’s experience, we also offer a hardware difference. Since we have the Crane system, we elevate the patients’ sternum bones and move them away from the heart, and we perform the surgery in this position. With this equipment, we not only minimize the risk of heart injury to almost zero, but also ensure that the patient is much less traumatized by turning the bar while the sternum bone had been up. After turning the bar, we make the lowering the sternum bone onto the bar. This ensures less pain and earlier recovery. We can compare this situation to changing a car tire. Before changing the tire, tiremakers raise the car by using a jack to lift the load of the car on the wheel. Then they take the wheel off and change the tire, unloaded. Finally, they put the wheel back on the car with the new tire and then lower the car onto the wheel. Think about it, how much damage would the undercarriage of the car be if the wheel was removed without raising the car while there was a load on the wheel, and after the work was done, the wheels were put on again without raising the car (normally this is not possible, but let’s assume it is)? We think that we have made a difference in this regard thanks to this hardware system, which is rarely available in clinics.

We think that we have made a difference in this regard thanks to this hardware system, which is rare in clinics. Although many clinics and many physicians state that they do not use this system because they do not need it, this is more than a need, it is actually a necessity, like the jack system used by tire shops. Moreover, with this system, the risk of heart injury is minimized (and we wouldn’t be wrong to say that it even provides zero risk). That’s why you should definitely ask whether your doctor has this equipment before having surgery.

While we reduce the patient’s surgical risks to zero, we do not rely only on the surgeon’s experience and crane system. We also offer other important advantages to minimize risks. In cases where we consider the patient to be very risky in terms of heart injury (for example, if the patient has had a heart surgery before and we are going to operate on that area for the second time, this is a risky situation), the artificial heart machine, which we call Ecmo (Extra-Corporeal Membrane Oxygenation) , is prepared for the surgery and a cardiovascular surgeon is ready in the operating room during the surgery. We also have systems that return lost blood to the patient, such as the Cell Saver system. For this reason, we perform our surgeries in JCI accredited hospitals with this equipment. Thus, in the event of a possible heart injury, we do not allow the patient to lose blood, and we ensure that the patient’s brain and other organs are fed with blood with the ecmo device, which will save us vital time while repairing the heart.

In summary, we have all this equipment and offer zero life-threatening risks to patients.

First of all, it is definitely more advantageous to place a silicone implant through a small incision instead of a major surgery such as pulling the muscle from the back to the front, which is routinely used in Poland Syndrome, and more incisions. For this reason, I recommend all Poland Syndrome patients to have this surgery.

Non-surgical treatments (Vacuum, Physical therapy and diet therapy) are always our priority for those who have Funnel Chest and those under the age of 17. However, when the cartilage at the bone ends of the patient hardens (the closure of the epiphyseal plates), that is, when the patient’s height growth stops (which corresponds to approximately 17-18 years), there is no longer treatment option without surgery. For this reason, our first choice at this age is Nuss (minimally invasive surgery) or, if Nuss cannot be performed, Ravitch (open surgery) techniques to replace the bone where it should be. Thus, heart and lung pressure is eliminated, the patient’s posture disorder is corrected, palpitations and impaired effort tolerance problems are eliminated.

However, Nuss and Ravitch surgeries have some risks and challenges for the patient. For example, during 1 months after Nuss surgery, the patient needs to take pain treatment, his/her movements are restricted and he/she needs care. He/She cannot do any sports during the following 3-6 months, and there will be some restrictions for doing sports during the 3 years after the surgery until the bar will be removed. Silicone implant is ideal for individuals who do not have the necessary time for a one-month recovery after surgery for reasons such as school or work, or who do not have anyone to take care of themselves, for individuals who are engaged in a sport and want to continue doing it. Some parents and patients do not want to take the risk of heart injury, which is very rare in Nuss surgery, although it is unlikely. In this patient group, it may not be appropriate for the patient to stay with the funnel chest. We offer an option for these patients to get rid of their “Mental Deformity”, especially the lack of self-confidence, and the bad appearance of the deformity in terms of aesthetics.

In fact, this method has been widely used in Europe for years, unfortunately, it is a method that we, as Turkish physicians, have been late in adapting to. In France, it is a common method that the president of the European Plastic Surgery Association, Professor Dr. Chavoin has applied to over 800 patients for more than 35 years. Silicones have been in their patients for 35 years and patients continue their lives without any problems. No life-threatening complications. He regularly presents these data at all international scientific meetings.

Moreover, the only one who performed this surgery is not only Dr. Chavoin but also it has been widely used for years all over Europe. This technique intrigued me also and we participated in 3 surgeries together with Dr. Chavoin at the Sagrat Cor University Medical Faculty Hospital in Barcelona/Spain. At there, he gave me all the surgery secrets I had to watch out for. He also took on my mentorship. I can reach him at any time I want and talk to him and ask what I want to ask. So, we are in close cooperation. Therefore, I have experience of 35 years and 800 patients behind me.