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You may not have heard of pectus excavatum — or "sunken chest," as it's commonly known — but there's a good chance you know someone who was born with it.
It's the most common deformity of the chest wall, affecting roughly one in 500 people — boys much more often than girls. And while sunken chest can be corrected with surgery, the procedure is invasive and very painful. Many families won't do it.
But a new method using magnets and an external brace, developed by Michael Harrison, a pediatric surgeon at the University of California, San Francisco's Benioff Children's Hospital, could provide an alternative to the surgery.
People with pectus excavatum have chests that are concave. Sometimes, the condition is evident at birth. Other times, it develops gradually. It's not life-threatening, but it can put pressure on the lungs and heart.
"They'll tell you they get very fatigued when they exercise vigorously," says University of Minnesota Medical School pediatric surgeon Daniel Saltzman. "In fact, there's a vicious circle set where they don't want to exercise so they sit out, play video games, things like that."
But probably the worst part, at least from the perspective of a teenage boy, is how it looks. For 14-year-old Justin Rosales, it's just embarrassing.
"I show my friends that I trust," he says. "But not that much."
Rosales is from Stockton, Calif. That's in the Central Valley, where the average July temperature is 94 degrees. But Justin never swims without a T-shirt, says his father, because he's embarrassed to show the indent in his chest.
Justin is an only child. His dad works two jobs, but the whole family drives an hour and a half to Benioff Children's Hospital in San Francisco, where Justin is taking part in Harrison's clinical trial for the new procedure. The magnet procedure is in its second Food and Drug Administration trial, with about 15 children taking part.
At the base of Justin's concave chest is a small scar. He's been implanted with a powerful magnet, just beneath the skin.
To demonstrate, Harrison holds up a little refrigerator magnet, which snaps to Justin's chest.
And that's pretty much how it works. Every day and night for about two years, Justin will wear an external brace containing a second, powerful magnet. If all goes well, the magnets will attract each other with enough force to gradually pull Justin's chest wall outwards.
Traditionally, doctors have used one of two surgeries to correct sunken chest. Saltzman, who operates on a few hundred patients a year, says both surgeries work well. But they're major procedures, requiring hospital stays. And he says the pain can be quite profound.
Some surgical patients stay on pain medication for months.
"Many of us surgeons have seen children become addicted to opiate narcotics because of pain meds they have to use," he says. "We've sent a couple to treatment to get them off their pain meds. It's very, very hard to watch."
So Saltzman is excited about the new technique that Harrison is developing. The magnets are virtually painless because they work gradually.
"The way to fix something that's structurally malformed like that is not to rip the whole thing apart and put it together over a matter of hours," Harrison says. "A better way to do it, and to think about it, is to fix it like the orthodontist does your kids' teeth — a tiny little bit, a millimeter every day."
The key, says Saltzman, will be getting patients into care while their chest walls are still soft. Wait until after puberty, and it may be too late for the magnets to work.
He's enthusiastic, he says, about any way to help these kids feel better about themselves.
"Once you repair the deformity and you see their self-esteem grow, like a flower opening when you water it, is spectacular," he says. "It's an amazing experience."