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Chest wall malformations – when a child’s breastbone isn’t shaped properly – can take a toll on a child’s physical and mental health. For some children, these malformations can cause heart and lung problems. Many kids with this condition also experience low self-esteem or negative body image because they look different from their peers.

At Atrium Health Levine Children’s, our team has decades of experience in chest wall reconstruction, helping kids improve their health and confidence.

About chest wall malformations

Chest wall malformations happen when a child’s chest cartilage doesn’t form properly. This can cause the breastbone to stick out or cave in. Children are born with these conditions, and they often get worse when a child has a growth spurt around puberty. The most common chest wall malformations are:

Pectus carinatum

In pectus carinatum, a child’s breastbone sticks outward rather than lying flat against their chest. Pectus carinatum can be a harmless condition, and many kids won’t need treatment. However, it may cause some children to experience chest pain, shortness of breath or an irregular heartbeat.

Pectus excavatum

Pectus excavatum is the most common chest wall condition, where the breastbone pushes inward, giving the chest a “scooped-out” appearance. While pectus excavatum is often harmless, some children need surgery so the chest bones don’t push down on the heart and lungs. Some families opt to fix the chest’s scooped-out appearance because their child feels self-conscious.

Chest wall reconstruction treatments

Your child’s treatment will depend on the type and severity of their chest wall malformation. Some children with mild forms of these conditions won’t need treatment, or can improve their condition with exercises to strengthen their chest and back and improve posture. Others may wear a brace for a few months to help mend their chest.

Kids with more severe chest wall problems may need surgery. This is typically for kids whose chest malformation causes heart and lung problems or self-esteem issues. We typically use one of two types of surgery:

Minimally-invasive chest wall reconstruction

Doctors may use a minimally-invasive procedure called the Nuss procedure to help kids overcome this condition. Our doctors are experts in performing the Nuss procedure and have taught physicians across the country how to do it.

During this operation, doctors will place a small metal bar to correct your child’s chest structure. First, we’ll fit a bar to be the exact shape of your child’s chest. Then, our thoracic surgeons make two small incisions and slide the bar inside your child’s chest.

This procedure takes about 45 minutes and creates an immediate cosmetic change. Kids typically stay in the hospital for a few days after this procedure and return to normal activities within a few weeks.

We’ll leave this bar in place for 2 to 3 years, stabilizing the breastbone in the same way braces work to straighten teeth. When it's time to remove the bar, the procedure takes about 30 minutes and patients go home the same day.

Traditional surgery for asymmetric chest walls

Some children with pectus excavatum have a crooked (asymmetric) chest wall. This happens when the cartilage in their chest grows unevenly, pushing the breastbone into the wrong place.

For these children, surgeons can reshape the cartilage in the chest wall, then move the breastbone to where it's supposed to be. This is a single operation and kids typically recover in a few weeks.

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How a steel bar can reshape a child’s future

Martin was born with a scooped-out chest (pectus excavatum), which impacted his self-esteem during his childhood and early teens. See how our team used the Nuss procedure to help him thrive.

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