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While some babies are born with a condition called pectus excavatum or sunken chest, most develop it during childhood or adolescence. This condition is caused by ribs and the breast bone not growing properly, resulting in a deformity in the chest. The chest has a concave or sunken appearance.

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Challenges of Sunken Chest

Children with pectus excavatum can often have chest pain and breathing difficulties, especially during exercise. Others may have palpitations, frequent respiratory infections or concerns about body image. This is caused by the depression of the chest wall and pressure put on the heart and lungs.

Nuss Procedure

Thanks to the advent of minimally invasive surgery and advanced techniques, WakeMed offers an operation called the Nuss Procedure that can correct this condition and allow for normal chest development in children. This surgery is recommended for children who are symptomatic from their pectus and are starting puberty and their major growth spurt. In some cases, the deformity may necessitate surgery at an earlier age.

The Nuss Procedure, named after the pediatric surgeon who perfected the surgery in the late 1980s, provides effective correction for children who are born with or subsequently develop sunken chest. Instead of a complicated open surgery, the Nuss Procedure offers a faster recovery, shorter hospitalization and less pain.

How Nuss Procedure is Performed

First, the child is given general anesthesia and receives both an intravenous and subcutaneous infusion catheters to control pain after surgery. Substaneous infusion catheters may also be placed, or cryoanalgesia may be used to cause a temporary "freeze" of the chest wall nerves. The pediatric surgeon makes two small incisions on either side of the chest so that a curved steel (or titanum) bar can be inserted under the sternum. Another tiny cut is made to insert a thoracoscope (attached to a small camera) into the chest. This instrument gives a clear field to visualize placement of the bar. Once the bar is in place, the surgeon affixes it to the ribs on either side and closes the incisions.

How Nuss Procedure Supports Development

Over time, the bar becomes secured with muscle and fibrous tissue that grows around it to lock the bar in place. The bar will remain in place to help support chest development for two to three years and will be removed during an outpatient procedure.

Hospitalization and Recovery

Children typically are hospitalized for two to three days so that they can be monitored to ensure the bar is stabilized and breathing is normal. Both patient and parents undergo training and education to understand how to manage movement during the critical first few weeks of recovery. Patients slowly resume normal activities, but sports and other contact-related activities are restricted for about six to eight weeks following surgery.

Additional Information


See our 2020 pectus excavatum outcomes

See our 2019 pectus excavatum outcomes

See our 2018 pectus excavatum outcomes

See our 2017 pectus excavatum outcomes