For far too long, bumps and depressions on the chest were wrongly dismissed as merely cosmetic issues. The potential ramifications to internal organs, such as the heart and the lungs, weren’t fully understood by parents or pediatricians.

But over time, more and more research-based evidence has shown the impact these chest wall conditions, if left untreated, can have on patients later in life.

The result? Earlier treatment for teenagers like Levi Reichard, 16, a pectus excavatum patient and competitive rower who won’t have to worry about future complications thanks to a referral and subsequent surgery at the Cincinnati Children’s Chest Wall Center.

During an annual exam last year, his family pediatrician noticed a small indention of Levi’s chest, which led to a referral for further evaluation. 

“To look at it, it didn’t look that severe. We were actually expecting to hear that it wasn’t that bad and he didn’t need the surgery, because it really wasn’t that noticeable,” said Marla Reichard, Levi’s mom. 

Referral to the Chest Wall Center Leads to Eventual Surgery

Meeting with Levi and family, pectus surgeon Victor Garcia, MD, agreed that it didn’t appear to be a severe case visibly, but he wanted to double-check with extensive testing to gather more information. 

The X-ray results showed mounting pressure around Levi’s heart. He was diagnosed with a severe case of pectus excavatum.

“The indentation on his heart was characteristic of one where he had a much greater likelihood of having issues as an adult,” said Dr. Garcia. 

Answering all of the family’s questions, Dr. Garcia and team outlined the various scenarios and explained the recommended surgery and recovery timelines.  

Levi and family felt confident in the proposed treatment plan. Added reassurance came from a friend of Levi’s who had undergone the same pectus excavatum surgery, with Dr. Garcia as his surgeon. Levi appreciated his friend’s perspective of what to expect.

“It was really good for me to be able to talk with someone before and after the surgery, who went through it and someone who I’ve known for like my entire life,” said Levi.

Surgery Corrects Levi’s Chest Wall

A surgery date was scheduled, and a few months later, Dr. Garcia and Rebeccah  Brown, MD, co-directors of the Chest Wall Center, performed Levi’s pectus surgery.

Using a minimally invasive technique, the surgeons inserted two bars, shaped to Levi’s specific chest contour, across his chest and just below the sternum. The bars will remain in place for at least three years as his chest is reshaped. 

The surgery itself was a success, but Dr. Garcia emphasizes that the measure of a successful pectus procedure goes beyond physical healing and extends to how much it improves a patient’s outlook.

“Levi now has new capabilities, not only from a physiologic standpoint, but also from a mental toughness standpoint,” explained Dr. Garcia. 

“You cannot predict the future, but you want to be able to know that whatever challenge is put before you, that you have the wherewithal—physically and mentally—to overcome it and not just survive, but to flourish in life. And Levi has that.” 

Levi’s Road to Recovery Made Easier with Goal in Mind

Levi flourished in his post-surgery recovery and exceeded all expectations in his return to rowing, but the first week at home wasn’t easy.  

While the family knew what to expect, they still had work to do in getting Levi comfortable. The catheter attached to his shoulder, a long tube which supplied much-needed pain medicine, was cumbersome. But each day was better than the next, and Levi gradually improved, with physical therapy (PT) beginning about a month after surgery.

“Everybody we encountered in the hospital—all the nurses and OT/PT staff and nutritionists—everybody was just fantastic,” said his mom, Marla. “We had such a great experience. I kept telling Levi, ‘We’re so lucky to live in Cincinnati, and this great hospital is right here for us.’”

Working with physical therapist Caity Trissell, Levi made quick progress in his recovery. They focused on different exercises each week, depending on what was needed for certain muscle groups, such as the neck, back and arms.

“Levi was very committed and dedicated to returning to rowing as soon as possible," said Caity. “He was enthusiastic each session and challenged me to continue to find exercises that appropriately challenged him to get ready for his return to rowing.” 

Unlike PT for athletes returning from an injury such as a torn ACL, therapy sessions are different for patients recovering from pectus excavatum surgery. 

“Over the years of having the pectus excavatum, their muscles and other tissues have adapted to the changing shape of their chest wall and rib cage," said Caity. “The change in shape of the chest wall leads to a lot of postural and strength imbalances, so we spend a lot of time in physical therapy addressing the underlying imbalances to improve posture and back strength.” 

The hard work paid off, and Levi was able to return to his favorite sport for winter conditioning with the Cincinnati Junior Rowing Club, where he competes with team members from across Greater Cincinnati.

“I needed to get back so I didn’t fall behind everyone else (on the team),” said Levi. “Having a specific goal in mind helps.”

For him, it was a desire to return to rowing as soon as possible. But both Levi and Caity agree that any goal—not just a return to sport, but even something as simple as sleeping in your own bed—can help any patient during therapy.   

Upon his return, it didn’t take long for Levi to discover he was a stronger rower than before the surgery. He continues to build up both his endurance and body mass, but more than anything he’s happy to continue his active lifestyle without any lingering concerns.   

“Being active has really become a part of who I am,” said Levi. “When I can’t be physically active, I’m not as happy.” 

(Published July 2022)