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Chest Wall Deformities in Children

Pectus excavatum (PE) and pectus carinatum are the most common chest wall deformities in children. At UVA, our highly skilled pediatric surgeons have nearly 40 years of experience with the modified Ravitch procedure to correct these anomalies.

About Pediatric Chest Wall Deformities

Both pectus excavatum (depressed breast bone) and pectus carinatum (protruding breast bone) occur more frequently in boys than girls. Signs of pectus excavatum usually show up in the first year of life, while pectus carinatum is usually found in adolescence (9-11 years old).

Both conditions are likely caused by overgrowth of the thoracic wall cartilage and tend to get more severe as the child grows. Associated conditions include:

Many children experience shortness of breath with exertion, or anterior chest wall pain with exertion. Even relatively mild deformities can create problems with self image.

Surgical Options for Pectus Excavatum & Pectus Carinatum

Some patients with pectus carinatum deformities can be treated with external braces, which are worn for 2-3 years. 

The Ravitch procedure involves making an incision in the anterior chest, removing the abnormal cartilage and bringing the breast bone to its normal spot in the body. A curved metal bar is then fitted to your child’s chest and placed beneath the breast bone. This bar stays in place for six months before it is removed.

The Nuss procedure involves two lateral incisions made instead of an anterior incision, without removing any cartilage. The breast bone is elevated with a metal bar, which is fitted to your child’s chest and placed beneath the breast bone. This bar stays in place for 2-3 years before it is removed. 

Candidates for Surgical Correction

At UVA, surgical correction of both pectus excavatum and pectus carinatum is offered once a child develops symptoms. Sometimes, patients with severe structural abnormalities are candidates for surgery even if they don't have symptoms. Most children have surgery between the ages of 10-16 years.

UVA's team monitors children with these disorders in our outpatient pediatric clinic until they show symptoms.

What to Expect After Your Child's Surgery

Typically, your child will recover in the hospital for five days following surgery. It usually takes about two weeks after discharge from the hospital before your child can resume normal activities.

They should avoid contact sport activities as long as the metal bar remains in place. The bar is removed with an outpatient surgical procedure and a very small incision over one end of the bar.

Our experience with several hundred pediatric patients with surgical correction of pectus anomalies shows that 90% of patients have an excellent result with long-term stability of the anterior chest wall. The operation is highly effective in eliminating the symptoms of chest pain and shortness of breath with exertion.

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