Nuss Procedure
The Nuss procedure is a minimally invasive surgery for patients with pectus excavatum, also known as concave or sunken chest.
Chest Wall Deformity
Chest wall deformities, or abnormally shaped chests, are a very common condition that affects about 1 in 500 people.
While some people are born with a chest wall deformity, many develop them during their adolescent growth spurt. The cause of these conditions is unclear, and treatment is usually required.
The team of specialists at Shriners Children’s treats chest wall malformations of all degrees. All treatment decisions are guided by internationally recognized pediatric surgeons who consider minimally invasive options for each patient. Our specialized medical team works collaboratively to ensure that children benefit from the finest, most advanced specialty pediatric care.
Conditions, treatments and services provided may vary by location. Please consult with the Shriners Children's location nearest you.
Symptoms of Chest Wall Deformities
Symptoms of chest wall deformity may include:
- Early fatigue during exercise
- Shortness of breath during exercise
- Chest pain
- Dizziness
- Racing heart
Occasionally a child may not have any of these symptoms. It is common for patients to experience psychological and emotional side effects such as negative body image, low self-esteem and social awkwardness. This is especially true for teenagers, as the pectus defect often worsens during the adolescent years, a time when the child may be seeking peer acceptance.
Chest wall abnormalities are reported as being more common in boys than girls, but a large number of girls have been undiagnosed due to their breasts covering significant bony deformities.
Types of Chest Wall Treatments
Pectus excavatum (sunken chest): The most common chest wall abnormality seen in children is pectus excavatum (PE), translated literally as “hollowed chest,” and also referred to as “sunken chest” or “funnel chest.” This is a condition in which a child's sternum is sunken into their chest, causing the chest to look hollow or dented. If severe, it can compress or displace the heart and lungs, causing shortness of breath that makes it difficult to exercise, chest pain, heart palpitations and difficulty swallowing.
Pectus carinatum (raised chest): In pectus carinatum, also known as “raised chest” or “pigeon chest”, the sternum protrudes outward. This type of condition is more commonly diagnosed in boys than girls as it is more obvious in boys. As in most chest wall abnormalities it can be present at birth or shortly thereafter, or it often becomes noticeable during the adolescent growth spurt and progresses until the child stops growing.
Poland syndrome: This rare type of chest wall deformity primarily impacts one side of the chest. It is characterized by underdeveloped components of the chest wall. Typically the affected side of the chest will have less muscle. Rib abnormalities are also common due to the unequal muscle development. The degree to which this happens varies from patient to patient.
Treatment and Management Approaches
Deciding on the best course of treatment for a chest wall deformity depends varies for each child. Your medical team at Shriners Children’s will build a customized plan of care to provide the best care possible for each unique individual. Our interdisciplinary team, led by pediatric surgeons, may also include orthopedic surgeons, physiotherapists, pulmonologists, medical imaging specialists, cardiologists, plastic surgeons, and other pediatric specialists.
The course of treatment will depend on the type of deformity and its level of complexity. Sometimes no treatment is recommended while other times bracing or surgery may be the best option for optimal outcomes. Specialized surgery to reshape the chest may be recommended.
Treatments include:
Nuss procedure: This is a minimally invasive surgery that places a stainless bar to fit the chest wall. The bar is inserted and secured through a small incision under each arm. The ends of the bar are secured to the chest wall. Typically Nuss bars are left in place for three years before being removed. The Nuss procedure takes approximately two hours and removal takes approximately one hour.
Cryoablation: This innovative technique involves freezing the nerves inside the chest wall to create an area of temporary numbness to decrease pain after surgery. The use of this treatment has significantly cut hospital stays and post-operative pain medicine.
Ravitch procedure: Historically the original treatment for chest wall abnormalities, the Ravitch procedure has almost entirely been replaced by the Nuss procedure. It is reserved for the most complicated chest wall conditions such as severe pectus carinatum. This procedure is performed through a horizontal incision across the mid chest where specific portions of cartilage are removed, allowing the sternum to move to a normal position. This procedure takes approximately four to six hours.
Chest braces: Pediatric Orthotic and Prosthetic Services (POPS), LLC, at Shriners Children’s designs and creates customized braces that apply direct pressure to the chest for children with pectus carinatum. This highly effective technique safely reshapes the chest without surgery.
Shriners Children’s is also currently conducting research to explore using minimally invasive magnetic technology to address sunken chest.
Conditions, treatments and services provided may vary by location. Please consult with the Shriners Children's location nearest you.
Davis is more confident now. His chest wall is dramatically more even, and you can't even tell that he's had an imbalance.
Locations that offer chest wall treatment
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Shriners Children's provides specialty health care to children around the world. We offer a comprehensive range of treatments, services and support to improve the quality of our patients’ lives and help them reach their full potential.
Pediatric Orthotics and Prosthetic Services, LLC
Shriners Children’s Pediatric Orthotics and Prosthetic Services, LLC (POPS) designs, fits and manufactures orthotics and prosthetics for children, from infants to teenagers to young adults. These devices – including chest braces – provide the support children need to meet their full potential. POPS is onsite at every Shriners Children's location. The close relationship between our staff and a center's medical staff allows us to work together to evaluate a child's needs and abilities.
Innovative Treatments
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Ravitch Procedure
Corrects severe or complex cases of pectus carinatum and pectus excavatum by removing the cartilage causing the defect. The sternum is then placed in the normal position.
Psychiatry & Psychological Services
Our psychologists at Shriners Children's specialize in evaluating and providing support to children and their families who are adjusting to a new diagnosis or having difficulty in their everyday lives due to trauma.
Next Steps
Request an Appointment
Families and caregivers seeking treatment should start by contacting us for an appointment.
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Parents and guardians of existing patients can email, request records, schedule appointments and more.
Refer a Patient
Physicians and healthcare providers can request appointments, start transfers or contact us with questions.