Ravitch Procedure

Also known as: pectus carinatum, pectus excavatum or combination chest wall deformity surgery.

What is Ravitch procedure?

Chest wall deformities are divided into 3 major categories. Pectus excavatum is when a child has sunken-in chest, pectus carinatum is when the chest protrudes outward and combination deformities usually have one side of the chest protruding while the other side is caved in. The Ravitch procedure is a surgery that can correct all these conditions. It was used extensively in the past but has given way to other methods as the first choices of treating chest wall deformities in most cases today.  

What happens during the procedure?

An incision is made in the patient’s chest, either vertically or horizontally depending on the specific deformity. Then the surgeon will expose the rib cage by retracting the pec muscles (pectoralis majors) to expose the ribs and sternum (breast bone). The surgeon will remove the cartilages connecting the ribs to the sternum, as these cartilages are what is causing the chest to bow out or sink in. Finally, the sternum is repositioned before the incision is closed. Over the next few months, the cartilages will regrow in the proper position.  Sometimes, the surgeon may brace the sternum in place with a small metal strut, and this is usually removed in about 6 months in an ambulatory procedure.

Is any special preparation needed?

Imaging tests are often required prior Ravitch procedure. A cardiology evaluation and pulmonary function tests are sometimes helpful.  The patient will be asked to work on good posture in the weeks leading up to surgery. Immediately before operation, the patient may need to avoid food, drink and certain medications before the procedure.

What are the risk factors?

Infection, pain, bleeding, difficulty moving, pneumonia, cosmetic imperfection and damage to surrounding organs and tissues are potential risks of Ravitch procedure, although these things are uncommon.

What is the recovery like?

Usually the patient is in the hospital for several days, during which time the pain team assists with medications to keep the child comfortable.  Breathing exercises and physical therapy are key components to a safe discharge. Most patients are back to the usual activities of daily living in a week or two, with full contact sports in 3 months.


Reviewed by: Cathy Anne Burnweit, MD

This page was last updated on: 8/9/2018 9:17:51 AM

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