Treatment for pectus excavatum is not always needed. When it is, children may have surgery to move the breastbone and make it stable until it heals into place. There are two options for this surgery:
- Ravitch repair
- Nuss procedure
Surgery for Pectus Excavatum
Your child's doctor will talk with you about each surgical option. In both options, we will give your child medicine to make them sleep without pain during the surgery (general anesthesia). After surgery, we will give your child pain medicine to make them comfortable. Most children will also see our Pain Medicine team. We will also show your child how to do some deep breathing exercises that are important during recovery.
The surgeon makes a long cut, or incision, across the chest below the breast line, and raises the chest muscles off the breastbone and ribs. Then the surgeon removes some of the cartilage that attaches the ribs to the breastbone, leaving behind the membrane that wraps around the cartilage. Next, the surgeon moves the breastbone to its new position and places a short stainless steel bar behind it to keep it in place. (To move the breastbone, the surgeon may need to take out a small wedge of bone.) Finally, the surgeon reattaches the muscles and sews up the incision.
The Ravitch repair takes about four to six hours, depending on the age of the child. Your child will be in the recovery room for another hour. Your child will stay in the hospital for about four to seven days.
As the area heals, cartilage grows and reconnects the breastbone to the ribs. When healing is done, in about six months, the bar is removed. Removing the bar is a day surgery. That means your child goes home the same day as the procedure.
The Nuss procedure is newer than the Ravitch repair. It has been used for more than 10 years. Many surgeons now choose the Nuss procedure over the Ravitch repair because it uses smaller incisions.
In the Nuss procedure, the surgeon inserts a long, stainless steel bar that is bent to the desired shape of the chest. It goes under your child's breastbone and in front of the heart. As the bar pushes the breastbone forward, it bends the cartilage that holds the breastbone to the ribs. The idea is that bone and cartilage will heal in that position.
During the operation, the surgeon makes three or four small incisions: One on each side of the chest to insert the bar and one or two to insert a telescope that helps the surgeon see how to safely position the bar. After positioning the bar, the surgeon sews up the incisions.
The Nuss procedure takes about two to three hours. Your child will be in the recovery room for another hour. Your child will be in the hospital for about four to seven days.
As with the Ravitch repair, in the Nuss procedure the bar stays in place during healing. Healing usually takes two to three years. Removing the bar is a day surgery. That means your child goes home the same day as the procedure.
After Surgery for Pectus Excavatum
After your child goes home, you’ll need to keep the incisions clean and dry until they heal. The surgery team will teach you how to care for the incisions and how to give your child pain medicine at home.
Another important part of home care is limiting your child’s activity while they recover. Your child should:
- Sit up straight without slouching for the first month.
- Avoid lifting anything heavy for a few months.
- Avoid playing some kinds of contact sports for about six months after the Ravitch repair and for three to four months for the Nuss procedure.
The surgery team will explain these and other limits before your child goes home.
About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.