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Pectus Excavatum: The Nuss Procedure

What Is Pectus Excavatum?

Pectus excavatum is a condition in which the breastbone (sternum) of the chest is caved in. This happens because several ribs and the breastbone grow abnormally. Pectus excavatum may be mild or severe. Severe pectus excavatum may cause problems with the heart and lungs.

What Is the Nuss Procedure?

The Nuss procedure is a surgery to correct severe pectus excavatum. It's considered "minimally invasive" because only a few small incisions (cuts) are needed.

What Happens During the Nuss Procedure?

The Nuss procedure has several steps. The surgeon:

  1. Makes two small cuts in the side of the chest.
  2. Places one or more steel bars behind the breastbone and attaches them to the outer edge of the ribs. They use a tiny camera to get the bars in the right place.
  3. Turns the bars, raising the breastbone.
  4. Places a metal plate (called a stabilizer), sutures (stitches), or wire to hold the bars in place.

The chest reshapes after about 2–4 years. Then the surgeon removes the bars.

What Happens After the Nuss Procedure?

Even though the Nuss procedure is minimally invasive, kids need pain medicine and rest after the surgery. They need to stay home from school for about 3 weeks. It may take 6 months or more for kids to return to all activities they did before the surgery.

For about 6 weeks after the surgery, kids should:

  • Do all breathing exercises (this helps prevent infection).
  • Walk or do other gentle exercises as recommended by the surgeon.
  • Avoid strenuous activity, including running.
  • Not drive.
  • Ride in the back seat to avoid possible trauma from an air bag.

They shouldn't play sports that could cause a chest injury (such as football, soccer, and baseball) until the surgeon says it's OK.

Are There Any Risks From the Nuss Procedure?

There are risks with any surgery, including bleeding, infection, and problems with anesthesia.

Specific risks for the Nuss procedure include:

  • pain that can last a month or more
  • bars that move out of place
  • fluid around the lung or a collapsed lung
  • damage to the heart or lungs during surgery
  • pectus excavatum that comes back

What Else Should I Know?

Pectus excavatum can make kids feel self-conscious about the way they look. It can also make it hard for them to exercise and play sports, and cause other health problems. The Nuss procedure can improve kids' emotional and physical well-being. The recovery time can be difficult, but most kids are happy with the results.

Reviewed by: Adela T. Casas-Melley, MD
Date Reviewed: May 10, 2023

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