Chest Wall Reconstruction

Chest wall malformations – when the breastbone doesn’t form properly – can affect your child’s physical and emotional well‑being. In addition to low self-esteem and negative body image, these conditions can lead to heart or lung problems that continue into adulthood. That’s why we care for both children and adults, including those who didn’t receive treatment when they were younger.

At Atrium Health Levine Children’s, our team-based approach brings together specialists who work closely to support your child’s needs. With decades of experience in chest wall reconstruction, we help your child improve both their health and their confidence.

About chest wall malformations

Chest wall malformations happen when a child’s chest cartilage doesn’t form properly. In addition to causing the breastbone to stick out or cave in, these conditions can lead to heart and lung complications. While children can be born with these conditions, they more commonly occur or get worse during growth spurts around puberty.

The most common chest wall malformations are:

Pectus excavatum

Pectus excavatum is the most common chest wall condition, where the breastbone pushes inward, giving the chest a “scooped out” appearance. This can impact a child’s heart and lungs. Symptoms often don’t appear until later in life and can include exercise intolerance or difficulty breathing. The appearance can also lead to significant concerns as the patient feels self-conscious.

Pectus carinatum

In pectus carinatum, a child’s breastbone sticks outward instead of lying flat against their chest. Some children may experience chest pain, shortness of breath or an irregular heartbeat. It’s usually less medically concerning, but frequently causes issues with self-esteem.

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 won’t need treatment, or may improve with exercises that strengthen the chest and back and support good posture. Others may wear a brace or external device for 1 to 2 years to help guide the chest to a healthier position.

Children with more severe chest wall problems may need surgery – typically when the condition affects the heart or lungs, or causes significant self-esteem concerns. We offer two types of surgery, along with an advanced pain control option that reduces or eliminates the need for strong narcotic pain medicines.

Minimally invasive chest wall reconstruction (Nuss procedure)

For many patients, the Nuss procedure offers a minimally invasive way to correct chest wall differences. Our surgeons are highly experienced and have even taught doctors across the country how to perform this surgery. We’re also one of only a few hospitals using a special technique that lets kids get back to normal activities – including sports – much sooner.

During the procedure, our surgeons make two small incisions and place two curved bars that match your child’s chest shape. The bars are linked together so they stay firmly in place. This helps prevent shifting, which used to keep kids out of activities for weeks. With our approach, most kids return to their routines shortly after surgery.

The surgery takes about 60 minutes, and the results are immediate.

The bars stay in place for about 3 years to help the chest maintain its new shape – similar to how braces help straighten teeth over time. When it’s time to remove them, 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 out of position.

For these children, surgeons can reshape the cartilage and move the breastbone to where it should be. This is a single operation, and most kids recover within a few weeks.

Cryoablation for pain control

Chest wall reconstruction can be painful, which is why we perform cryoablation during the procedure. Cryoablation is an advanced pain control technique that freezes the nerves, keeping the chest numb for up to 2 months. This helps patients go home sooner and recover more comfortably, often without needing strong narcotic pain medicines.