Pediatric Chest Wall Program

Children and young adults with chest wall conditions, including pectus excavatum, pectus carinatum and slipping rib syndrome, get expert, attentive care from the team at UCSF Benioff Children's Hospitals. Families come from across the United States and around the world for specialized evaluations and innovative treatments, some of which were pioneered and published by UCSF.

We offer nonsurgical and surgical therapies as well as second opinions, partnering with families to figure out the treatment option that is best for their child. Virtual care consultations are available for California families, making care more convenient.

Our surgical team is highly experienced in chest wall surgery for children. We use advanced techniques, including the Nuss procedure and intercostal nerve cryoanalgesia, to improve recovery, reduce postoperative pain and minimize the need for opioid pain medications. Our refined approach to the Nuss procedure, also known as pectus bar placement, helps most patients return home after a one-night hospital stay.

Highlights of our approach to chest wall care include:

• 1,000+ Nuss procedures. We have performed more than 1,000 Nuss procedures over more than 20 years, making us one of the most experienced pediatric chest wall programs in the West.
• Personalized evaluation and treatment plan. We tailor our assessment and treatment plan to your child's age, symptoms, health history and personal goals.
• Collaborative team of specialists. Our surgeons collaborate with experts in cardiology, pulmonology and other pediatric specialties to support the best possible outcome for your child.
• Nonsurgical options. Vacuum bell therapy and bracing can improve many mild to moderate chest wall deformities.

Pediatric chest wall deformities care

Chest wall conditions can cause uncomfortable symptoms, such as shortness of breath and chest pain. They may also make children self-conscious. Our chest wall specialists use a range of therapies to correct these conditions, reduce symptoms and help your child feel confident.

We assess and treat a wide range of chest wall deformities, from mild to severe, including:

• Pectus excavatum
• Pectus carinatum
• Pectus arcuatum
• Slipping rib syndrome
• Costal margin flaring
• Harrison's groove
• Jeune syndrome (short rib dysplasia)
• Poland syndrome
• Sternal clefts

Our pediatric surgeons coordinate with other UCSF pediatric experts in:

• Anesthesiology
• Pain medicine
• Cardiology
• Pulmonology
• Radiology
• Genetic counseling
• Plastic surgery

We work together to give your child a comprehensive evaluation, personalized treatment plan and seamless care from diagnosis to recovery.

If your child needs imaging, we offer lower-dose options to minimize their radiation exposure. UCSF's child life specialists are available during procedures to ease anxiety and help children feel more comfortable.

Nonsurgical chest wall deformity treatments

When possible, we use the least invasive treatment that provides your child with the best long-term outcome. Sometimes, we can manage mild to moderate deformities with:

• Observation. We monitor the condition over time, tracking your child's growth, symptoms and chest development to determine if they need treatment.
• Vacuum bell therapy. Children with pectus excavatum may use a suction device that gently lifts the breastbone forward with regular use over time. This treatment is typically most effective for mild to moderate deformities and for younger children, who tend to have a more flexible chest wall.
• Bracing. Your child may wear a brace that reshapes their chest wall over time. Our pediatric orthotics and prosthetics experts fit your child for a custom brace and adjust it as they grow.

Specialized chest wall surgery

Our surgeons have extensive experience performing minimally invasive and traditional (open) procedures to treat chest wall conditions. We tailor your child's procedure to their needs and goals. Our pediatric anesthesiologists make sure your child is safe and comfortable before, during and after their procedure.

Minimally invasive procedures

When appropriate, minimally invasive techniques, such as the Nuss procedure, can support your child's recovery. Our surgeons use small incisions and specialized instruments to repair certain conditions, including:

• Pectus excavatum
• Pectus carinatum
• Slipping rib syndrome (for patients seeking improved cosmetic outcomes)

Complex and reoperative procedures

Our skilled team treats rare and complex chest wall conditions, including those requiring additional treatment following previous surgery. Our surgeons carefully plan your child's procedure and answer any questions you have.

For complex or specialized chest wall conditions, we may recommend:

• Harrison's groove repair
• Modified Abramson repair of pectus carinatum using pectus bars
• Modified Ravitch procedure, when appropriate
• Redo Nuss procedure (revision surgery)
• Sternal cleft reconstruction
• Sternal distraction for thoracic insufficiency associated with Jeune syndrome (short rib dysplasia)
• Thoracoscopic chondrotomy for pectus carinatum

Cryoanalgesia for pain management

UCSF specialists pioneered the use of intercostal nerve cryoanalgesia to reduce pain after minimally invasive chest wall surgery. During the procedure, we use extremely cold temperatures to temporarily interrupt pain signals from specific nerves between the ribs. Sensation gradually returns as the nerves recover.

This pain management option can reduce postoperative pain, shorten the hospital stay, speed recovery and lessen the need for opioid medications. At UCSF, most patients return home after a one-night hospital stay following the Nuss procedure.

Improving chest wall surgery through innovation and research

Our team has developed and published several innovative surgical techniques that expand treatment options for children with chest wall deformities. These innovations reflect our commitment to advancing pediatric chest wall care through clinical research, surgical innovation and improved patient outcomes.