Chest Wall Deformity Center

Johns Hopkins All Children's offers an innovative approach to the treatment of chest wall deformities, including pectus excavatum.

Deformities of the chest can have a major impact on a child’s health.  Whether the chest sinks in or protrudes out, the result can influence a child’s ability to breathe, exercise, and even change how a child feels about his or her appearance.  Specialists dedicated to chest wall deformities at Johns Hopkins All Children’s Hospital can provide your child with the corrective treatment he or she may require.

Offering Specialized, Advanced Care

The pediatric surgeons at Johns Hopkins All Children’s Hospital are experts in the diagnosis, evaluation and treatment of common and complex chest wall deformities, including pectus excavatum (funnel chest), pectus carinatum (pidgeon chest), slipping rib syndrome, congenital rib anomalies and more. Using evidence-based, leading-edge treatment, including minimally invasive surgery, we are making a difference in the lives of children with complex chest wall deformities.

Why Choose Johns Hopkins All Children’s Hospital?

Chest wall deformities are fairly common.. Pectus excavatum, or funnel chest, occurs in about one in 500 children and accounts for over 90 percent of congenital chest wall deformities. These children benefit from the expertise of experienced pediatric surgeons trained in the latest minimally invasive treatments. At Johns Hopkins All Children’s, we offer:

  • Comprehensive treatment for pectus excavatum, pectus carinatum (protruding chest), Jeune syndrome (condition in which the rib cage is smaller and narrower than usual), Poland syndrome (condition in which the chest muscle is underdeveloped or absent) and slipping rib syndrome.
  • Pediatric surgeons who work closely with neonatologists, maternal-fetal medicine specialists, pediatric cardiologists, pediatric pulmonologists, pediatric anesthesiologists and other specialists to provide highly customized and efficient care.
  • An innovative approach to treatment that emphasizes pre-operative preparation and counseling for patients and families. Patients undergo evaluation by a pediatric cardiologist (heart specialist) and a pediatric pulmonologist (lung doctor). Once a thorough preoperative evaluation is completed, Nicole Chandler, M.D., and Paul Danielson, M.D., both leaders in minimally invasive chest wall surgery, determine the best treatment plan for each individual patient.

About the Procedure

Gain a better understanding of minimally invasive pectus excavatum repair surgery by watching this short video containing photos and video footage of the procedure.

Pectus Excavatum Frequently Asked Questions

What is pectus excavatum?

Pectus excavatum is the most common chest wall deformity where the sternum (breast bone) and ribs develop abnormally. This causes the sternum to drop inward toward the spine producing a caved in or sunken appearance to the chest.  It is sometimes referred to as “funnel” chest.  Pectus excavatum is three times more common in boys than girls.

What causes pectus excavatum?

The exact cause of pectus excavatum is not known.  It may be a result of imbalanced growth of the sternum and ribs. Recent information suggests there may be a genetic component. It is associated with musculoskeletal disorders such as scoliosis and Marfan’s syndrome, which suggests that abnormal connective tissue may play a role.  However, the majority of patients with pectus excavatum do not have any musculoskeletal disorders.

What symptoms does pectus excavatum cause?

Many patients do not have any symptoms.  Some may experience chest pain, shortness of breath or difficulty in performing athletic activities.  In the most severe cases, children state they are not able to keep up with their peers in competitive athletic activity.  Some patients report increased stamina or exercise tolerance following surgery.

The most common symptom of pectus excavatum is psychological–many children develop a negative body image and become self-conscious about the appearance of their chest. This may lead them to avoid activities that may draw attention to their chest, such as swimming or changing clothes in the presence of others. In some cases, this may even led to social withdrawal.

How is pectus excavatum repaired?

There are several surgical options to correct pectus excavatum.  The one we offer most commonly is the minimally invasive repair of pectus excavatum (MIRPE), also commonly known as the Nuss procedure.

In this procedure, two small incisions are made on both sides of the chest, near the arms. A second very small incision is made on the right side of the chest where a camera is inserted to watch the procedure from inside the chest.  A metal bar that spans the width of the chest is formed to each patient’s deformity.  It is then passed under the breastbone (sternum) with the help of the camera in the chest cavity.  The bar lifts up the breastbone and corrects the deformity.  Typically, the bar is left in place for two to three years.

What is the recovery from the Nuss Procedure like?

Following surgery, most patients spend three to five days in the hospital.  The chest wall deformity team at Johns Hopkins All Childrens Hospital has developed and employs a recovery plan that focuses on patient comfort, a quick return to activity, and an avoidance of urinary catheters, epidural catheters, and excessive blood and x-ray testing while hospitalized.  This recovery pathway has been so successful that the results have been published in scientific medical journals.  Once at home, most patients are able to resume their full activities, including sports and weight lifting within three months. Contact sports, such as football and hockey and sports that require swinging such as golf, may be restricted longer.

Contact Us

Schedule an appointment online or call 727-767-4170, or 800-456-4543, ext. 4170, for more information.