The Nuss procedure reshapes a sunken chest by placing a metal bar beneath the chest wall to push it outward. Surgeons make small incisions (often as short as three centimeters) on the sides of the chest to insert metal bars. Then they use a camera to guide them as they fix the bar in place. These bars are left in place for 2-3 years. When the chest can hold the new shape on its own, the bars are removed.
A sunken chest wall can interfere with breathing and heart function. If this is the case for your child, we can use the Nuss procedure to create more space for the heart and lungs to work properly. Having a typical chest shape also enables kids to engage in sports and other activities they couldn’t or wouldn’t try before. Our patients report feeling healthier, more confident and enthusiastic after this procedure. The Nuss procedure is generally safer than other invasive chest wall operations, which involve cutting away cartilage (the soft material that also forms the structure of your nose).
The Nuss procedure doesn’t have many side effects. Some children can have an allergic reaction to the steel bar in their body. We test all our patients before the procedure to see if they’ll have an allergic reaction. We can use a titanium bar if there is an allergy risk. Children can sometimes feel the bar shift slightly when they take a deep breath. About 3% of all patients see their chest sink inward again in the years after the bar is removed.
During your child’s first visit, we will talk about their health history, perform a physical exam and take pictures of their chest shape. We can almost always diagnose their condition without doing X-rays or other imaging. Depending on your child’s condition, we may run tests on their heart and lungs. If they have pain or trouble breathing when they’re playing or exercising, we can take measurements while they’re on a treadmill to understand how their chest wall affects them when they’re active. If you and your child choose the Nuss procedure, we will test your child for metal allergies and give them a simple exercise plan to follow. Good posture, muscle support and flexibility will help your child’s recovery.
The surgery is performed under general anesthesia. We will also use a technique called cryoablation to freeze some of the nerves in their chest area, to reduce pain while they recover. The frozen nerves grow back and regain function within two to three months. The period after surgery is very important for making sure your child’s chest properly sets into its new shape. They’ll have to restrict their activity and movements for six to eight weeks. This includes sleeping on their backs, avoiding rough play and sports, and being careful not to slouch, twist their torsos or raise their elbows above shoulder height. We take extra steps - like using special surgical techniques and medications - to keep pain to a minimum. Children may feel some pain and soreness but may need pain medication for only a few days after their surgery. Your child will have follow-up clinic visits to ensure proper healing and to answer any questions. The chest wall is most likely to hold its new shape after the bar has provided support for at least three years. After three years, we will look at your child’s progress and make a plan for removing the bar.
You can take as long as you like to decide whether and how to treat your child’s pectus excavatum. The ideal time to do the Nuss procedure is when your child has already begun their major adolescent growth spurt. For girls this is generally age 12 or older, and for boys it’s 13 or older. We want them to be done or mostly done with this growth phase by the time we take the bar out, so that their chest can maintain its new shape in the future.
The condition does not resolve on its own. If your child wants to have a typical chest shape - or needs to have one, because of issues with their heart or lungs - they will need to be treated at some point. It is easier to recover from the Nuss procedure as a teenager than it is later in life.