Pectus excavatum, a condition where the breastbone is sunken, can be corrected through a minimally invasive technique known as the Nuss procedure. This surgery involves placing one or more custom-shaped metal bars behind the sternum to push it forward into a more typical position. Over time, the chest cartilage and bones remodel around the bars.
The Immediate Post-Operative Period
Following the Nuss procedure, patients are moved to a post-anesthesia care unit for observation. The hospital stay ranges from three to seven days, and pain management is a primary focus. Initially, pain is controlled with an epidural catheter or cryoablation, a technique that freezes chest nerves to reduce pain signals.
As recovery progresses, patients transition to patient-controlled analgesia (PCA) and eventually to oral pain relievers. Activity is restricted in the first few weeks. Patients are taught to avoid bending or twisting their torso and to use a “log-roll” technique—keeping the spine straight—when getting in and out of bed to prevent dislodging the bar. Deep breathing exercises are also encouraged to help lung function.
Living with the Pectus Bar
The bars inserted during the procedure remain in place for about three years to allow the chest wall to solidify in its new position. Patients can return to school or desk work within a few weeks, though a full recovery can take about six months.
Restrictions on physical activity are lifted in stages. Non-contact sports may be approved after about three months, while activities involving heavy lifting or potential chest impact remain off-limits. Some individuals report feeling the bar, and occasional clicking sounds are normal. Patients are given a medical card for airport security, as the bar can trigger metal detectors.
Aesthetic and Functional Improvements
The most noticeable result of the Nuss procedure is the cosmetic change to the chest’s contour. The surgery elevates the sunken sternum, creating a flatter chest shape that is visible right after the operation. This aesthetic improvement can lead to significant psychological benefits, including enhanced body image and self-confidence.
The procedure also yields functional improvements. Pectus excavatum can compress the heart and lungs, leading to symptoms like shortness of breath and reduced exercise tolerance. By relieving this compression, the surgery improves cardiopulmonary function. Patients experience easier breathing, better circulation, and an increased capacity for physical activity.
Bar Removal and Long-Term Stability
After two to three years, a second, less complex procedure is performed to remove the pectus bar. It is often done as an outpatient or short-stay procedure under general anesthesia. Recovery from the removal surgery is much quicker, with less associated pain.
The long-term stability of the correction is excellent. The chest maintains its corrected shape once the bar is removed, with a low risk of the sternum sinking again. Potential complications include displacement or rotation of the bar, which stabilizers are used to minimize. Other rare risks include infection, allergic reactions to the metal bar, and injury to the heart or lungs during the initial surgery.