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The Ravitch Procedure

What is the Ravitch Procedure?

The Ravitch procedure involves removing the firm portion of the cartilage that holds the chest in an improper position. (Cartilage is the flexible, firm material that also forms the structure of your nose.) The procedure is a three- or four-hour operation, during which your child is asleep under general anesthesia. 

During the procedure, our surgeons scrape away some of the cartilage attached to the bone in the center of the chest (the sternum). They’re 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.

What are the benefits of the Ravitch Procedure?

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.

What are the side effects of the Ravitch 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 and runs along — and partially blends into — the lower edge of the chest muscles. 

 

What are the risks of the Ravitch Procedure?

There are some rare risks associated with the Ravitch procedure. Worldwide, 5 to 10 percent of all patients see their chest abnormality come back. There is a slight risk of damaging the lungs during the procedure. 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 for the incision to become infected. In some patients, the cartilage in their chest ends up becoming stiff or doesn’t grow, which creates discomfort as the child ages. An extreme version of this, known as asphyxiating thoracic dystrophy (ATD) or acquired Jeune’s syndrome, can severely inhibit breathing, because the chest wall becomes inflexible and the lungs don’t have enough room to expand.

What to expect with the Ravitch Procedure?

We'll use a series of appointments to plan your child's surgery, and to make sure they stay healthy and heal after the surgery is over.

 

What to expect before the Ravitch Procedure?

During your child’s first appointment, 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. Then we will talk about the nature of your child’s particular anatomy and their options for treatment. 

Some patients decide to do treatment right away, while others think about it for weeks or months. We offer our perspective but never pressure you in one direction or another.

If you and your child opt for the Ravitch procedure, we will confirm that the procedure is covered by insurance before scheduling surgery. 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.

Two weeks before surgery, your child will come in for tests to see how they will react to anesthesia. They’ll also talk to our team about what their follow-up care will look like.

What to expect during the Ravitch Procedure?

The surgery usually lasts three to four hours. Your child will be unconscious throughout the procedure. 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, and one parent is welcome to stay with them.

What to expect after the Ravitch Procedure]?

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 make pain management easy during recovery. Children will need pain medication for a few days after their surgery. 

Your child will have a follow-up appointment two weeks after surgery, to see how things are going and address any pain or other issues they may have. We’ll see them again after two months, when we’ll talk about increasing their activity and keeping up with their exercises to support their posture and health in the future.

How do I prepare my child for the Ravitch Procedure?

We do a physical exam and take pictures during the initial appointment, so your child should dress comfortably and be prepared to take off their shirt. You will be with the child during the entire appointment. Girls keep their bras on, and we have strict measures in place to safeguard the images and information we gather.

To prepare for the procedure and follow-up period, the most important thing is for your child to follow the exercise plan we set up for them. Building strength in their chest, back and core will help them recover and quickly get back to normal activities.

What questions should I ask my provider about the Ravitch Procedure?

  • How many of these procedures do you do each year?
  • What other treatments do you do for my child’s condition?
  • How do you decide between the Ravitch procedure and other treatment options?
  • What is your approach to pain management?

The Ravitch Procedure Doctors and Providers

 

Frequently Asked Questions

  • What happens if we do nothing? 

    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.