Understanding Your Procedure

---

Surgical correction of pectus excavatum aims to reposition the sternum and restore the normal contour of the chest wall. In most patients this also relieves compression of the heart, which in pectus typically presses on the right side and displaces it leftwards. Where exercise limitation was demonstrated before surgery, exercise capacity usually improves, though this happens gradually over months rather than immediately.

Correction is now performed minimally invasively in the great majority of patients, across all age groups — a change from earlier practice, when open surgery was standard and correction was largely confined to adolescents. The Ravitch procedure is reserved for the smaller number of cases in which this is not feasible, such as markedly asymmetric or mixed deformities, pectus arcuatum, or revision after a failed repair. Even then, a purely open operation is uncommon; most are managed with a hybrid approach combining limited cartilage work with bar fixation.

Modern Nuss correction is considerably more involved than when the technique was first described, and this explains both the length of the operation and the recovery that follows.

Sternal elevation. Before the bars are placed, the sternum is lifted forwards using a crane or lifting device. This opens the space behind the sternum, makes bar passage safer, and reduces the force needed during rotation.

Multiple bars. Most patients now receive two or three bars rather than one. Spreading the correction across several points gives a more even result and substantially reduces the risk of a bar displacing.

Bilateral stabilisers. Plates are fixed at both ends of each bar, anchoring it to the ribs and preventing rotation or migration.

Hammock sutures. Sutures are passed around the bar and the adjacent ribs to form a supportive sling, further securing the construct.

Flare busters. Where the lower ribs flare outwards, either pre-existing or accentuated once the sternum is lifted, additional sutures are used to control this and improve the overall contour.

Together these refinements have made the operation more reliable and displacement far less common than it once was.

In hospital. Most patients stay between three and five days, depending on pain control and mobility. You will be helped out of bed the day after surgery, and walking begins straight away. Breathing exercises start immediately and matter more than they appear to — they keep the lungs expanded, prevent chest infection and help posture. Pain relief is adjusted daily with the aim of having you comfortable on tablets before you go home.

The first six weeks. Pain settles steadily, though it is usually worst in the first week to ten days. Sleep on your back rather than on your side, avoid twisting, bending and lifting, and do not push, pull or carry anything heavy. Posture work starts early: the bars hold the sternum, but the muscles have to learn the new position. Most patients are walking comfortably within a fortnight.

Six weeks to three months. Most return to school, university or office work within two to four weeks, and to more physical work by six to eight weeks. Driving is usually possible at four to six weeks, once you can perform an emergency stop and turn to check blind spots without hesitating. Light activity, swimming and cycling resume gradually.

Three to six months. Non-contact sport is usually permitted from around three months. Contact and combat sports, heavy lifting and anything with a risk of a direct blow to the chest are avoided for longer, and the timing is individual.

Follow-up appointments through this period check the position of the bars and the correction achieved.