Chest Wall Program


Doctor giving a presentation

The Chest Wall program at Shriners Hospitals for Children – Northern California provides children the most advanced pediatric medical care. The expert pediatric surgery team coordinates care for several kinds of chest wall irregularities.

The most common chest wall abnormality seen in children is Pectus Excavatum (PE), translated literally as “hollowed chest” and also referred to as “sunken chest” or “funnel chest.” This is a condition in which a person’s breastbone is sunken into their chest, causing the chest to look hollow or dented.
Diagram of "Pectus Excavatum"
If severe, it can compress or displace the heart and lungs causing shortness of breath, chest pain, palpitations and respiratory disease. Some patients also suffer psychologically and emotionally as a result of the disorder. Negative body image, low self-esteem, and social awkwardness. This is especially true for teenagers as the pectus defect often worsens during the adolescent years, a time when the child may be seeking peer acceptance.

Fortunately, our internationally noted pediatric surgeons can correct chest wall issues with minimally invasive surgery. Above all, our medical team works together to ensure that children benefit from the most advanced pediatric medical care.

Medical Concentration
  • Pectus Excavatum (Sunken Chest)
  • Pectus Carinatum (Raised Chest)
  • Poland’s Syndrome
Patient Evaluation

Chest wall malformations are not readily apparent in all patients. Symptoms vary with the severity of the abnormality, and younger children are less symptomatic than older children. Mild breathing problems and chest pain in the area of the rib cartilages require medical evaluation. To find out more information about how to make an appointment, please visit this page.

What is the Cause of Pectus Excavatum?

The cause of pectus excavatum is not known however it occurs in approximately 1 out of 300–400 children and is three to five times more common in males than females. This may be an isolated abnormality or may be found with other malformations including scoliosis, kyphosis, and connective tissue disorders such as Marfan syndrome. The deformity usually becomes more severe as the child grows.

What are Some Symptoms Associated with Pectus Excavatum?

  • Chest or rib pain
  • Limited stamina with exercise
  • Shortness of breath and respiratory disease
  • Palpitations
  • Some patients also suffer psychologically and emotionally as a result of the disorder.
  • Negative body image, low self-esteem, and social awkwardness.

How are Pectus Conditions Typically Treated?

Pectus treatments range from simple observation to bracing and in some cases, surgery. Talk openly and honestly with your child about the condition to determine how this is affecting their health and well-being. The psychological impact can be significant to some children. At Shriners Hospitals for Children – Northern California, pediatric surgery is delivered in a hospital designed specifically to serve the medical and emotional needs of children and their families. Our internationally noted pediatric surgeons can correct chest wall abnormalities with minimally invasive surgery.

What are the Different Types of Surgical Repair for Pectus Deformities?

  • Patients with Pectus Excavatum typically undergo the Nuss Procedure (bottom section move up to top). Nuss Procedure, which is known to be the minimally invasive repair with a metal pectus bar, is achieved by bending a bar to fit the chest wall. The bar is then inserted and secured through a small incision under each arm using the aid of an endoscope to monitor and avoid injury to the heart during insertion. The bar goes over the ribs and under the sternum, to push the sternum forward into the new position. The ends of the bar are secured to the chest wall. The bar is kept in place for 2-3 years and then removed. This Nuss procedure takes 2-4 hours and removal takes 1-2 hours. Patients who undergo a Nuss Procedure typically stay in the hospital for 1-3 days. Nuss bar removals are an outpatient procedure, with discharge occurring the same day as the operation.
  • Patients with Pectus Carinatum may choose to undergo a Ravitch Procedure. Ravitch Procedure is done through an up and down incision across the mid chest. In this repair, the abnormal costal cartilages are removed. This procedure takes approximately 4–6 hours. In certain patients, an osteotomy (a break) in the sternum is done to allow the sternum to be positioned more typically. Sometimes, a temporary metal chest strut (bar) may need to be placed during the operation. Patients who have a Ravitch procedure typically stay in the hospital for 1-3 days.

Meet the Team

Four pediatric surgeons and a pediatric nurse practitioner work together to deliver complex, compassionate care.

Diana Farmer, M.D.
Pediatric Surgeon in Chief

Shinjiro (Shin) Hirose, M.D.
Director, Pediatric Surgery

Gary Raff, M.D.
Pediatric Cardiothoracic Surgeon

Amy Rahm, M.D.,
Pediatric Cardiothoracic Surgeon

Jennifer Miranda
Nurse Practitioner

Kat Swartz
Nurse Practitioner