Pediatric Pectus Excavatum

What is pectus excavatum?

Pectus excavatum (sometimes called cobbler's chest, sunken chest, or funnel chest) is the most common chest deformity, affecting between 1 in 300 and 1 in 500 adolescents. It is caused when several ribs and the sternum grow abnormally, which produces a caved-in or sunken appearance of the chest. Pectus excavatum is usually congenital (present at birth) and can get worse during the early teenage years, a time when bones grow rapidly.Because it affects the appearance of children, pectus excavatum can cause psychological and social problems. Moreover, it can hamper the ability of the heart and lungs to function normally, and can cause pain in the chest, back and elsewhere.


In moderate and severe cases, pectus excavatum may require surgery, which has proven very effective at correcting the condition and its psychological and physical effects. The most common types of operations are the Nuss procedure and the Ravitch technique. Children’s National’s team of experts in the Chest Wall Deformity Program can help families determine the best treatment option for their child.

Thoracoscopic Nuss procedure

The Nuss procedure is more popular because it requires much smaller incisions and is minimally invasive. Surgeons make two incisions on either side of the chest, through which they insert a curved steel bar under the sternum. The surgeons flip the bar so it pushes outward on the sternum. The bar usually stays in the body for about two years. When the bones have solidified into place, the bar is removed during a same-day operation.

Ravitch technique

Using the Ravitch technique, surgeons create an incision along the chest, through which they remove cartilage and detach the sternum. They then implant a small bar beneath the sternum to raise and hold it up in the desired position. The bar is left in position until the cartilage grows back, and can support the chest in a normal position. That usually takes about 1 to 2 years. The bar is then removed during a same-day operation.

Children's Team

Children's Team



Matthew Oetgen

Division Chief, Orthopaedic Surgery and Sports Medicine
Anthony Sandler

Anthony Sandler

Senior Vice President and Surgeon-in-Chief Joseph E. Robert, Jr., Center for Surgical Care


Orthopaedic Surgery and Sports Medicine

From sprains and strains to complex congenital, Children’s National offers one of the most experienced pediatric orthopaedic practices in the nation with experience in treating all areas from head to toe.

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"A piece of advice; if your child has surgery on the dominant hand first, be sure you budget plenty of time to be their caregiver as they will need help with homework, getting dressed, and maybe even eating."

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