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Our Approach | Overview

The Pectus and Chest Wall Treatment Program at Boston Children's Hospital evaluates and treats children and young adults using state-of-the-art methods to improve the quality of life for each patient entrusted to our care.

You will meet our multidisciplinary team of chest wall experts. This includes experienced surgeons, nurse practitioners, pain management anesthesiologists, and therapists. Our approach is focused on the patient, with the goal of selecting the right treatment plan for the anatomy, symptoms, and goals of your child.

What are the treatment options for pectus excavatum?

In a child with a pectus excavatum, it's unlikely to affect their heart or lung functioning. In these kids we offer vacuum bell therapy to slowly “pull” the sternum forward twice a day and correct the appearance of the chest. This approach is ideal for younger children or those with less severe pectus excavatum.

In a child with a more severe pectus excavatum it’s more likely to affect their heart and/or lung functioning along with the impact on their self image. In these kids we offer two surgical options, the Nuss procedure and Welch procedure. There are several things to be considered in deciding which operation is best for you and your child and these will be discussed with you by your chest wall surgeon.

What are the surgical options for pectus excavatum?

Nuss procedure

The most common operation we perform for pectus excavatum is the minimally invasive repair, or Nuss procedure. In this operation, the surgeon makes small incisions on the side of the chest. The surgeon then inserts one or more bars across the chest, pushing the breastbone forward. No cartilage is removed, and the scars are small and on the sides of the chest. The bar is left in place for three years to maintain the correct shape and is then removed in a second short operation. For a few months after placement, your child will have to refrain from certain activities that may cause the bar to shift.

Welch procedure

In this operation, called the Welch procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and breastbone, and repositions the freed-up breastbone. A bar is left in the chest wall to maintain the correct shape for six months. During this time, your child will have to refrain from activities that might involve a collision, like football. While this technique leaves a visible scar in the center of the chest, it requires a shorter period with the bar in place.

What are the treatment options for pectus carinatum?

We base our treatment of pectus carinatum on the severity of the condition and its effect on your child physical and mental health. For kids with a mild pectus carinatum, an exercise regimen may be all that is recommended. For kids with a more severe case, we may recommend a customized brace that non-operatively reshapes the chest over time. For kids with an unusually severe case, we may recommend the Welch procedure.

Safety and comfort

When it comes to chest wall surgery, our top priorities are safety and comfort. We use state-of-the-art equipment in the operating room to ensure your child has the best possible outcome with the lowest possible risk. This includes the use of "sternal elevation" and video camera guidance to ensure optimal Nuss bar placement. During and after the operation, our team of pediatric anesthesiologists work to help control pain so that your child has a smooth, comfortable recovery.