Specialized Rib and Breastbone Care

Pectus deformities affect approximately one in 400 individuals and become more severe during adolescence. With this in mind, our chest wall care team at AdventHealth for Children offers the latest nonsurgical and surgical treatment options for pectus excavatum (sunken chest), pectus carinatum (pigeon chest) and other complex chest wall disorders.

We can help you and your child understand their condition and any impact it may have on their growth, health and self-esteem. If surgery is needed, we offer innovative procedures, including the Ravitch (open approach) and Nuss procedure, a minimally invasive option for reduced scarring and a faster return to daily life for your child.

Find the right pediatric thoracic specialist or location that’s convenient for you.

Christopher Anderson, MD, FACS

Medical Director

Ashleigh Kittle - Peds Surgery APRN — Ashleigh Kittle, APRN

In this video, Dr. Chris Anderson, our medical director of pediatric surgery and the chest wall clinic, discusses what parents should know about pectus excavatum and pectus carinatum. He covers the differences, what recovery looks like and the advancements that have made these procedures much safer in recent years.

Question: What is pectus excavatum (sunken chest)?

Answer:

Pectus excavatum is when the sternum (breastbone) is pushed into the chest due to costal cartilage. The defect can apply pressure and displace the heart and lungs. Pectus excavatum correction surgery can be performed by pediatric thoracic surgeons, cardiothoracic surgeons and orthopedic surgeons. Treatment options include the suction bell, Ravitch (open) surgical repair, and the Nuss (minimally invasive) repair. The defect typically worsens during adolescent growth spurts and can be corrected starting at 12 years old.
Question: What is pectus carinatum (pigeon chest)?

Answer:

Pectus carinatum is when the sternum (breastbone) is pushed outward from the chest due to abnormal cartilage, causing a pigeon chest. The defect does not apply pressure to the heart or lungs, but can cause atypical chest pain and breathlessness on exertion. Carinatum defects can be treated non-invasively with bracing at almost any age, or surgically during adolescent years.
Question: What are the different treatment options?

Answer:

The Ravitch (open approach) and Nuss procedure (minimally invasive approach) are two surgical options. We also offer intraoperative cryoablation therapy (temporary freezing of nerves) for postoperative pain management, which allows most patients to be discharged 2 to 3 days after surgery. Postoperative activity will be tailored for each patient based on surgical approach and condition.
Question: What happens during the Ravitch procedure?
Answer:
During the Ravitch procedure, the following steps are performed:
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An incision is made across the child’s chest

The rib cartilage is reshaped

One or more drains are placed under the skin to drain fluid from the surgery site

A chest tube may be placed to prevent the lungs from collapsing before the incision is closed

In the months after surgery, the cartilage grows and keeps the breastbone in the new position.

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Question: What happens after the Ravitch procedure?
Answer:
Your child will need pain medicine and rest after the surgery. He or she will need to stay home from school until prescription pain medicine isn't needed.

For about six weeks after the surgery, your child should:
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Take all medicines as prescribed by the surgeon

Do all breathing exercises (this helps prevent infection)

Walk or do other gentle exercises as recommended by the surgeon

Avoid gym class at school

Not carry a backpack or other heavy items

Avoid strenuous activity, including running

Ride in the back seat to avoid possible trauma from an airbag in the event of an accident

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Question: What happens during the Nuss procedure?
Answer:
During the Nuss procedure, the following steps are performed:
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The surgeon makes two small cuts on each side of the chest

One or more bars are placed behind the breastbone and attached to the outer edge of the ribs; the surgeon will use a tiny camera to get the bars in the right place

From there, the surgeon turns the bars, raising the breastbone

A metal plate (called a stabilizer), sutures (stitches), or fiberwire will help hold the bars in place

The chest reshapes after 2 years, at which time the bars are typically removed as an outpatient procedure. Your child may return to normal activity, except contact sports, six weeks after surgery.

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Question: What happens after the Nuss procedure?
Answer:
Even though the Nuss procedure is minimally invasive, your child will need pain medicine and rest after the surgery. He or she will need to stay home from school for about three weeks.

For about six weeks after the surgery, your child should:
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Do all breathing exercises (this helps prevent infection)

Walk or do other gentle exercises as recommended by the surgeon

Avoid strenuous activity, including running

Ride in the back seat to avoid possible trauma from an airbag in the event of an accident

Your child should not play sports that could cause a chest injury (such as football, soccer and baseball) until the surgeon says it's OK.

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Bobby’s Story
Kealey’s Story

Bobby’s Story

“My son Bobby was born with pectus excavatum. We were initially told it would resolve on its own, but as he continued to grow, it wasn’t improving. Our pediatrician referred us to Dr. Anderson, and after evaluation, we learned his pectus was crushing his heart.

I am forever grateful to this team for helping my son. From the doctors to the nurses and everyone in between, everyone was wonderful and diligent with his needs. They knew exactly what he needed pre- and post-surgery. When he sees a needle, he’ll pass out. The nurses were so patient trying to get him his IV. We couldn’t have asked for a better experience.” – Pamela, Bobby’s Mom

Kealey’s Story

“Dr. Anderson and the AdventHealth for Children team were amazing. From the consultation to pre-op, through surgery and aftercare, all our questions were answered, and we were treated with compassion and care. The Nuss procedure was a success, and our athlete was back to dancing in no time. We are so grateful for Dr. Anderson and his expert support team.” – Brandy, Kealey’s Mom

Pediatric Chest Wall Clinic

Specialized Rib and Breastbone Care

Location Details

AdventHealth Medical Group Pediatric Surgery at Orlando

Meet the Team

Christopher Anderson, MD, FACS

Ashleigh Kittle, APRN

What to Know About Pectus and Chest Wall Deformities

Answers to FAQs About Chest Wall Conditions

Question: What is pectus excavatum (sunken chest)?

Question: What is pectus carinatum (pigeon chest)?

Question: What are the different treatment options?

Question: What happens during the Ravitch procedure?

Question: What happens after the Ravitch procedure?

Hear From Families Just Like Yours

Find Care Near You

AdventHealth Medical Group Pediatric Surgery at Orlando AdventHealth Medical Group Pediatric Surgery at Orlando

Pediatric Chest Wall Clinic

Specialized Rib and Breastbone Care

Location Details

AdventHealth Medical Group Pediatric Surgery at Orlando

Meet the Team

Christopher Anderson, MD, FACS

Ashleigh Kittle, APRN

What to Know About Pectus and Chest Wall Deformities

Answers to FAQs About Chest Wall Conditions

Q:Question: What is pectus excavatum (sunken chest)?

Q:Question: What is pectus carinatum (pigeon chest)?

Q:Question: What are the different treatment options?

Q:Question: What happens during the Ravitch procedure?

Q:Question: What happens after the Ravitch procedure?

Q:Question: What happens during the Nuss procedure?

Q:Question: What happens after the Nuss procedure?

Hear From Families Just Like Yours

Find Care Near You

AdventHealth Medical Group Pediatric Surgery at Orlando AdventHealth Medical Group Pediatric Surgery at Orlando

Question: What is pectus excavatum (sunken chest)?

Question: What is pectus carinatum (pigeon chest)?

Question: What are the different treatment options?

Question: What happens during the Ravitch procedure?

Question: What happens after the Ravitch procedure?

Question: What happens during the Nuss procedure?

Question: What happens after the Nuss procedure?