Pectus Excavatum

Pectus excavatum is the most common chest wall deformity in children. It results from abnormal growth of the cartilage — the soft, flexible tissue attached to the sternum or breastbone — causing the chest wall to curve inward. The condition is often apparent at birth and typically becomes more severe over time. It occurs more frequently in boys than in girls.

In most children, this deformity poses no health risk and surgical repair is done primarily for cosmetic reasons. Surgical repair requires a follow-up outpatient procedure, performed one to two years after the surgery.

Pectus excavatum is generally repaired in one of two ways. The traditional approach involves a long incision across the chest to remove the deformed cartilage. The sternum is then moved forward and secured in the corrected position with metal struts. This operation takes about four hours to complete.

Another approach involves inserting a stainless steel "pectus" bar through a Band-Aid size incision on each side of the chest. The pectus bar is inserted through one of the side incisions and placed under the sternum, moving it forward. The bar is then secured to the chest wall. This operation takes about one hour.

In both operations, all stitches are placed under the skin. These stitches dissolve, so no stitches are removed after the operation. Your child's incision will be covered with small bandages.

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The pectus excavatum repair is a painful procedure. The length of your child's hospital stay will depend on his or her pain level after the operation. Most children stay in the hospital for about five days after the operation. An epidural catheter, which is placed in the back, is used to give continuous pain medication for several days, when the pain is the greatest. While the epidural is in place, your child will also have a catheter in the bladder to drain urine. In addition, your child may be given oxygen with a small tube under the nose.

After a few days, pain medication is given orally and the epidural is removed. In some children, it may be necessary to place a small tube or tubes in the incision to drain fluid. These are removed when the drainage stops, usually after several days. You can help speed your child's recovery by encouraging deep breathing, walking and sitting in a chair, as soon as possible after the operation.

If all goes well, we recommend a visit to the Pediatric Surgery office between two and four weeks after your child leaves the hospital. We also recommend a visit with your child's pediatrician one to two weeks after discharge from the hospital.

Please keep the following in mind after bringing your child home following the pectus excavatum repair:

  • Pain — When your child leaves the hospital, you will be given a prescription for pain medication to take to your local pharmacy.
  • Activity — To avoid dislodging the pectus bar, we recommend no contact sports for at least a month following surgery. Except for that restriction, your child can go about his or her activities as usual.
  • Bathing — Your child may bathe or shower after the epidural catheter is removed. When your child is home, he or she may bathe or shower without restriction.
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Reviewed by health care specialists at UCSF Benioff Children's Hospital.

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UCSF Clinics & Centers

Orthopedic Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 353-2967
Fax: (415) 353-2299
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Surgery Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 476-2538
Fax: (415) 476-2929
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