Nuss Procedure

Also known as: Nuss procedure for pectus excavatum, pectus excavatum surgery.

What is pectus excavatum surgery?

The Nuss Procedure for pectus excavatum is a medical procedure used to treat pectus excavatum, also known as funnel chest or sunken chest. In our country, about two thirds of these deformities present during the adolescent growth spurt, while one third of patients have the problem from infancy.

Approximately one in 1,000 children suffers from pectus excavatum, a congenital deformity of the chest in which the sternum or breastbone faces inward, applying pressure to the heart and lungs. This disorder can restrict the growth of the vital chest organs, becoming more serious as a child grows up. Symptoms of this disorder may include chest pain, mitral valve prolapse, heart palpitations, respiratory disease and exercise intolerance.

Our pediatric surgical team has applied an innovative surgical treatment to correct this condition, with numerous benefits to young patients. Using the minimally invasive Nuss procedure children usually can return to their normal activities in about a month.

Teenage patient with pectus excavatum after surgery
Pectus excavatum correction, before and after surgery.

What happens during the Nuss Procedure?

Pectus excavatum surgery is performed under general anesthesia. Two incisions are made in the sides of the chest in line with the deepest part of the central deformity. A steel bar or two is inserted below the sternum, under the direct vision of an internal camera (a thoracoscope), in order to force the rib cage outward. The bar remains in place for several years, usually about 4, until the new chest contour is stable. The bar is then removed in a second surgery, after which about half of patients go home the same day.

Pectus excavatum surgery requires only a few incisions, reducing scarring, and requires approximately 40 minutes, compared to the four to six hours required for chest reconstruction. Blood loss is also minimal compared with other procedures.

Is any special preparation needed?

Most children need imaging studies, a cardiology evaluation and pulmonary function tests. Just before the operation, the patients may need to avoid food, drink and certain medications. This is a major medical procedure that requires a stay of 4 to 5 days in the hospital.

What are the risk factors?

Infection, pain, swelling, difficulty walking or moving, pneumonia, cosmetic imperfection or damage to surrounding organs are potential risks of pectus excavatum surgery, along with other more unusual ones. These complications are not common and most children have uneventful convalescence.

What about recovery?

A pain team is involved in managing the discomfort after this major reconstructive surgery.  Most children are out of bed the day after the operation and go home in two to five days. Breathing exercises and physical therapy are an important for a succesful recovry. Most patients will be back to most of their normal activities within a month, with full contact sports in about two months.

Pectus excavatum surgery provides excellent long-term functional and cosmetic results, making it easier for the child to breathe, while restoring normal chest expansion and proper lung and heart growth.

Florida's Leader in the Treatment of Chest Wall Deformities in Children and Teens

The Chest Wall Deformity Center offers both traditional surgeries as well as minimally-invasive operations for pectus excavatum treatment. Options are reviewed and a course of treatment for pectus excavatum is selected with imput from the family, based onthe severity and asymmetry of the defect. Operative repairs is customized to best correct the specific condition noted in each patient.

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Reviewed by: Cathy Anne Burnweit, MD

This page was last updated on: October 02, 2019 08:59 AM