Figure 1

• The exact cause of pectus carinatum is unknown. It does run in families, so there is some inherited tendency for the condition.
• It occurs more frequently in boys than girls.
• It is not noted in almost one-half of the affected children until after their 11th birthday.
• A mild deformity noted at birth or in early childhood often worsens as the child grows, particularly at puberty.
• An association with scoliosis is seen in 15 percent of children with pectus carinatum.

• nurse practitioner who works with the surgeon
• nurse
• anesthesiologist
• lab technician to have your child's blood drawn.

Figure 2

• An incision will be made across the chest in between the nipples.
• The breastbone and the cartilage portion of the ribs, which are producing the protrusion, are then exposed.
• The bulging portion of the cartilage is then removed leaving behind the membranes surrounding the cartilage, which will regrow cartilage.
• The front wall of the breastbone is then divided so the breastbone can be displaced backward into a normal position completing the correction of the anterior protrusion.
• The muscles are then rejoined to the chest and the skin incision is closed.
• Figure 2 shows the same boy following his surgical repair.

• A member of the anesthesia department will meet with you and your child before surgery. He or she will take a health history, perform a physical exam, discuss the plan for anesthesia, and answer any of your questions.
• Your child will be asleep under general anesthesia for this procedure. Vital signs will be fully monitored throughout the surgery. A nurse anesthetist, an anesthesia resident, or an anesthesia attending will be at their side throughout the procedure.
• The surgery requires insertion of a breathing tube while your child is asleep. Additional IV lines and a bladder catheter may be required.

• After the operation, you will go to the recovery room, and then be transferred to the surgical floor after approximately one to two hours.
• You may have a small drain beneath the incision which will be taken out one to two days after operation.
• You will be encouraged to walk on the first day after the operation.
• You can eat/drink if you are feeling well enough the day after surgery.
• You will need to return to your surgeon's office approximately two weeks after your operation.

There are two ways your child's pain can be managed: PCA pump or Epidural catheter.

• The PCA pump (Patient Controlled Analgesia) requires you/your child to push a button on the pump. This sends a dose of the pain medicine into your child's IV. There are safety mechanisms to prevent you/your child accidentally getting too much of the pain medicine.

• The Epidural catheter (similar to what is used during childbirth) is a continuous infusion of pain medicine through a small catheter in your child's back. The catheter may be inserted before the beginning of the surgery while your child is well sedated. Because local anesthetic (like numbing medicine at the dentist's) is used, some numbness or weakness may temporarily be noticed after surgery. Occasionally, patients may complain about itching from epidural pain medication.

• develops redness or swelling around the wound
• has drainage or bleeding from the incision
• has a fever of 100.5 degress or greater
• has severe pain that does not get better with pain medicine, or
• develops shortness of breath.