The Ravitch procedure involves removing the firm portion of the cartilage that holds the chest in a concave shape (Cartilage is the flexible yet firm portion of the anterior chest wall). The procedure is done under general anesthesia and involves removal of abnormally shaped cartilages. Surgeons are careful to leave behind part of the cartilage that will grow and flex as your child ages. After removing the cartilage, surgeons reposition the sternum and ribs, and insert thin braces under the ribs and sternum to hold the chest in its new shape. These braces dissolve in six months. By then, new cartilage has grown and naturally keeps the chest’s new shape in place.
Some irregular chest shapes can interfere with a child’s breathing and heart function. In those cases, the Ravitch procedure creates 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. Overall, our patients report a greater sense of well-being, confidence and enthusiasm in the months and years following this procedure.
The Ravitch procedure doesn’t have many side effects. Your child will have to restrict their activity for six to eight weeks after the procedure. Some kids experience mild pain following surgery. The incision forms a scar that is about three to six inches long. Approximately 5 to 10% of all patients see their chest abnormality come back. On rare occasions, surgery will accidentally dislodge cartilage from the sternum, and that can cause breathing problems for the child later on. After the procedure, there is a slight risk the cartilage in their chest ends up becoming stiff, which creates discomfort.
During your child’s first visit, we will discuss 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. Then we will talk about the nature of your child’s particular anatomy and their options for treatment. Having good posture, muscle support and flexibility is very important for your child’s recovery, so we’ll give them a modest exercise plan to follow.
At operation, 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 six or eight months. After the procedure, most patients stay in the hospital for two or three days.
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. Your child will have follow-up appointments after surgery to ensure proper healing and to address any questions.
Your child’s condition will 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 Ravitch procedure as a teenager than it is later in life.