Chest Wall

The chest wall provides essential protection for the heart, lungs, and major blood vessels while contributing to normal respiratory mechanics and overall chest structure. Conditions such as pectus excavatum, characterized by a depression of the breastbone, pectus carinatum, characterized by outward protrusion of the chest, and chest wall tumors can affect physical function, appearance, and quality of life.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., and his team provide specialized evaluation and advanced surgical treatment for a range of chest wall disorders. Treatment is individualized according to each patient's anatomy, symptoms, and underlying condition, with minimally invasive techniques considered whenever appropriate.

If you are experiencing symptoms or concerns related to a chest wall condition, a comprehensive surgical evaluation can help determine the underlying problem and identify appropriate treatment options. Contact the Institute for Thoracic Surgery to schedule a consultation.

Chest Wall Disease

The chest wall is a complex structure composed of the ribs, sternum, cartilage, muscles, connective tissues, nerves, and overlying soft tissues. It protects the heart and lungs, contributes to normal breathing mechanics, and provides structural support for the upper body. Disorders of the chest wall range from relatively common traumatic injuries and benign structural abnormalities to complex benign and malignant tumors requiring specialized surgical and oncologic care.

What Causes Chest Wall Disease?

Chest wall conditions may be congenital, traumatic, inflammatory, infectious, degenerative, or neoplastic. Congenital abnormalities such as pectus excavatum and pectus carinatum result from abnormal development of the cartilage and chest wall. Other conditions may develop later in life following trauma, previous surgery, infection, inflammatory disease, or disorders affecting bone, cartilage, or connective tissue.

Chest wall fractures are most commonly associated with blunt trauma, falls, motor vehicle accidents, sports injuries, or other significant impacts. Although many rib fractures can be treated without surgery, selected patients with multiple, displaced, or unstable fractures may benefit from surgical stabilization, particularly when chest wall instability or impaired respiratory mechanics is present.

Chest wall masses and tumors represent another important category of disease. Benign tumors may arise from bone, cartilage, muscle, or soft tissue and include lesions such as lipomas, fibrous tumors, and certain cartilage or bone tumors. Malignant tumors may originate within the chest wall, including sarcomas and other cancers, or may extend into the chest wall from adjacent structures or represent metastatic disease. Because chest wall tumors are diverse and relatively uncommon, accurate diagnosis and staging are essential to determining the appropriate treatment strategy.

Symptoms of Chest Wall Disease

Symptoms vary considerably according to the underlying condition. Patients may notice:

• A visible lump, mass, depression, or protrusion of the chest

• Chest wall pain or tenderness

• Pain associated with breathing or movement

• Shortness of breath or reduced exercise tolerance

• Swelling or changes in the contour of the chest

• Instability following rib or sternal injury

• Persistent or enlarging chest wall mass

• Fatigue or other symptoms associated with an underlying malignancy

Some abnormalities are primarily structural or cosmetic, while others can interfere with breathing, cause significant pain, or involve the lungs, heart, nerves, or other nearby structures.

How Is Chest Wall Disease Evaluated?

Evaluation begins with a detailed medical history and physical examination, including assessment of the location, size, mobility, and characteristics of any mass or structural abnormality. Imaging is an important component of the evaluation and may include chest X-ray, CT, MRI, or other specialized studies depending on the suspected diagnosis.

When a tumor is suspected, obtaining an appropriate tissue diagnosis and establishing the extent of disease are important steps before definitive treatment. Imaging may also be used to determine whether a lesion involves the ribs, sternum, muscles, lung, mediastinum, blood vessels, or other adjacent structures.

For suspected malignant chest wall tumors, current expert consensus emphasizes accurate diagnosis and staging, multidisciplinary treatment planning, and careful surgical planning when resection is appropriate.

Multimodality Treatment for Chest Wall Disease

Treatment is determined by the underlying diagnosis, location and extent of disease, symptoms, and the patient's overall health. Not every chest wall condition requires surgery. Some fractures, benign lesions, and structural abnormalities can be managed with observation, medication, physical therapy, or other nonsurgical treatment.

When cancer is present, treatment may involve a multimodality approach, combining surgery with medical oncology and radiation oncology when appropriate. Depending on the tumor type and stage, systemic therapy or radiation may be administered before or after surgery, or surgery may not be the primary treatment. Multidisciplinary evaluation is particularly important for chest wall sarcomas and tumors involving adjacent organs or major structures.

Surgical Treatment and Chest Wall Reconstruction

When surgery is indicated, the objective is to remove the underlying disease while preserving or restoring the structural and functional integrity of the chest wall. Procedures may include surgical stabilization of rib fractures, excision of benign tumors, biopsy or diagnostic procedures, wide resection of malignant tumors, and resection of tumors that extend into the chest wall from the lung or other organs.

For selected tumors, complete surgical removal with appropriate margins may provide the opportunity for definitive local treatment. More extensive resections can involve portions of one or more ribs, the sternum, muscle, or overlying soft tissue. When a substantial portion of the chest wall must be removed, reconstructive surgery may be required to restore stability and protect the underlying organs. Reconstruction can involve mesh or other prosthetic materials, biologic materials, and muscle or soft-tissue flaps, depending on the size and location of the defect.

The surgical approach is individualized. Minimally invasive and robotic techniques may be appropriate for selected procedures, particularly when the disease can be safely addressed through limited access. More extensive disease may require an open approach to achieve complete resection and appropriate reconstruction. The goal is not simply to use the smallest incision, but to select the surgical approach that provides safe, complete treatment while preserving chest wall function whenever possible.

Specialized Chest Wall Care

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., provides specialized evaluation and surgical treatment for a range of chest wall disorders, from traumatic injuries and benign abnormalities to complex chest wall tumors. When appropriate, treatment is coordinated through a multidisciplinary approach involving thoracic surgery, medical oncology, radiation oncology, radiology, pathology, and reconstructive surgery.

For complex chest wall disease, careful coordination among these specialties allows the treatment plan to address not only the underlying disease, but also the structural integrity, respiratory function, and long-term quality of life of the patient.