Our Approach

The Pectus and Chest Wall Treatment Program at Boston Children's Hospital evaluates and treats children and young adults using state-of-the-art methods to improve the quality of life for each patient entrusted to our care.

You will meet our multidisciplinary team of chest wall experts.  This includes experienced surgeons, nurse practitioners, pain management anesthesiologists, and therapists.  Our approach is focused on the patient, with the goal of selecting the right treatment plan for the anatomy, symptoms, and goals of your child.

What are the treatment options for pectus excavatum?

If your child has a mild case of pectus excavatum, an operation may not be necessary. A shallow excavatum is unlikely to affect heart or lung functioning. 

Can I treatment pectus excavatum without surgery?

If your child wants to correct their chest wall shape without surgery, we offer vacuum bell therapy to slowly “pull” the sternum forward twice a day.  This approach is ideal for younger children or those with less severe pectus excavatum.

What are the surgical options for pectus excavatum?

If the deformity is causing physical, self-image, or social problems, it can be surgically repaired. There are two surgical options, both of which require your child to be put under general anesthesia.

Minimally Invasive Repair

The most common operation we perform for pectus excavatum is the minimally invasive repair, or Nuss procedure.  In this operation, the surgeon makes small incisions on the side of the chest.  The surgeon then inserts one or more bars across the chest, pushing the breastbone forward.  No cartilage is removed, and the scars are small and on the sides of the chest. The bar is left in place for 3-4 years to maintain the correct shape.  For a few months after placement, your child will have to refrain from certain activities that may cause the bar to shift.

Open Repair

In this operation, called the Ravitch or Welch procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and breastbone and repositions the freed-up breastbone. A bar is left in the chest wall to maintain the correct shape for six months. During this time, your child will have to refrain from activities that might involve a collision, like football. While this technique leaves a visible scar on the chest, it requires a shorter period with the bar in place and is ideal is certain types of chest wall deformities such as pectus carinatum or mixed defects such as pectus arcuatum.

What are the treatment options for pectus carinatum?

We base our treatment of pectus carinatum on the severity of the condition and its effect on your child.  For mild cases of pectus carinatum, no treatment may be required.  For many cases, we offer a customized brace that gradually reshapes the chest. In rare cases, your child’s doctor may recommend an operation similar to the open repair for pectus excavatum.

Safety and Comfort

When it comes to chest wall surgery, our top priorities are safety and comfort.  We use state-of-the-art techniques to ensure your child has the best possible outcome with the lowest possible risk.  This includes the use of ‘sternal elevation’ and video camera guidance to allow safe placement of the bar behind the sternum.  During and after surgery, our team of pediatric anesthesiologists work to help control pain so that your child has a smooth, comfortable recovery.