The Pectus and Chest Wall Treatment Program evaluates and treats children and young adults with a wide variety of chest wall deformities. As one of the busiest chest wall treatment programs in the country, we have deep experience in all levels of care: from nonsurgical treatment to minimally invasive surgery, or — when clinically necessary — open surgery. Thanks to our extensive experience, we can ensure each of our patients receives the most appropriate care for their condition.
Our multi-disciplinary team includes surgeons, nurses, and nurse practitioners, as well as pain management anesthesiologists, certified orthotists, pulmonologists, and cardiologists. And because we are part of Boston Children’s Hospital, ranked among the country's best hospitals by U.S. News & World Report, our patients have access to a full range of specialized skills and resources to meet their clinical needs.
We understand that every child is different. Because of this, getting to know each patient, their goals and interests, and how their chest wall affects their daily life is an essential part of care at Boston Children’s.
From diagnosis to treatment planning and each stage of care, we work to ensure our patients and their families have the best possible experience. This includes making sure we answer all of our patients’ and families’ questions, providing the least invasive treatment options, and — when a patient needs surgery — offering effective pain management and services for a safe return to activity.
Clinical experience in chest wall care
We have decades of experience caring for patients with chest wall deformities. Our specialties include:
- pectus excavatum, an indentation of the breastbone
- pectus carinatum, an outward protrusion of the breastbone
- pectus arcuatum, a condition involving both a protrusion of the upper breastbone and indentation of the lower breastbone
- Poland syndrome, when part of the chest and shoulder area do not develop fully
- sternal cleft, when the breastbone is not fully fused
- slipping rib syndrome, where the lower ribs “slip” or move and cause pain
History of innovation in treating chest wall deformities
Boston Children’s clinicians helped define the treatment of chest wall problems.
- In 1958, Dr. Kenneth Welch popularized a technique to treat pectus excavatum known as the Welch procedure.
- Dr. Robert Shamberger refined this approach and made important discoveries about the effects of pectus excavatum on lung and heart function.
State-of-the-art diagnosis and treatment
In this spirit of innovation, we continue to explore new ways to improve the standard of care for our patients. Below are some of the newest techniques we offer.
Diagnostic innovation: White light scanning
White light scanning creates three-dimensional (3D) images of the chest. This provides the most accurate chest wall measurements while also decreasing exposure to radiation through CT scanning, x-rays, and other diagnostic imaging.
Non-surgical treatment: Vacuum bell therapy and bracing
For many children with mild to moderate pectus excavatum or pectus carinatum, vacuum bell therapy or bracing can make surgery unnecessary. We now initiate care with these non-operative techniques and only recommend surgery if the condition persists after treatment. Boston Children’s is one of the first hospitals to offer this plan of care.
- Vacuum bell therapy uses a device placed on the chest of a child with pectus excavatum. The device creates suction that slowly pulls the breastbone forward over time.
- Bracing can treat mild to moderate pectus carinatum in young children whose chests are still flexible.
Minimally invasive surgery: Nuss procedure
For patients with pectus excavatum which is severe or those whose condition does not improve through non-surgical treatment, we offer a minimally invasive repair known as the Nuss procedure. For this procedure, a surgeon inserts a metal bar under the sternum through a small incision on the side of the ribcage. This bar presses the sternum forward and remains in place until the child has finished growing, typically three years. Our surgeons have performed the Nuss procedure hundreds of times over the past two decades.
Pain management: Cryoablation
We utilize cryoablation during surgery to help minimize post-operative pain. Cryoablation uses cold temperatures to reduce the pain signals sent to the brain. This method of pain management has been proven to reduce the length of patients’ hospital stays, decrease the need for narcotic pain medication, and improve recovery time.
Safety and comfort before, during, and after surgery
Patient safety and comfort are our top priorities anytime a chest wall issue requires surgical treatment. We use state-of-the-art equipment in the operating room to ensure your child has the best possible outcome with the lowest possible risk.
Well before a scheduled surgery, our anesthesiologists meet with our patients and their families to agree on a pain management plan that both the patient and family are comfortable with. During and after the operation, our team of pediatric anesthesiologists work to control pain so that your child has a smooth, comfortable recovery.
Our Pectus and Chest Wall Program works closely with a variety of different specialties within Boston Children’s Hospital. If your child needs additional care for connective tissue, heart, or lung concerns, or scoliosis, we work closely with our colleagues who specialize in these fields to ensure all of your child’s medical needs are cared for.