Pectus correction (sunken or protruding chest) (Pectus excavatum / carinatum correction)

What is pectus correction?

Pectus conditions are differences in the shape of the chest wall. In pectus excavatum the breastbone and ribs are sunken inwards (a 'funnel' chest); in pectus carinatum they are pushed outwards (a 'pigeon' chest). They are usually noticed in childhood and often become more obvious during the teenage growth spurt, so younger patients are common.

For most people these are mainly about appearance and how they feel about their body, and many have no physical problems. A minority with severe pectus excavatum can have symptoms such as breathlessness on exertion or, occasionally, effects on the heart, because the sunken breastbone presses on it.

Treatment depends on the type, the severity and the person's goals. Pectus carinatum can often be improved with a brace worn over months, especially while a young person is still growing. Pectus excavatum may be corrected surgically — most commonly the Nuss procedure (a curved bar placed behind the breastbone through small side cuts to push it forward, left in for a few years) or the Ravitch procedure (an open operation reshaping the cartilage and breastbone). Surgery changes the chest shape and can relieve symptoms in selected people, but it is a significant operation with real risks, and it is not a guaranteed or without risks 'fix'.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Nuss compared with Ravitch (for pectus excavatum)

Both are significant operations. The right choice depends on age, chest flexibility, the shape and the surgeon's assessment, not on a single 'best' technique.

Preparing for your surgery

• Ask whether your concern is mainly about appearance or whether there are real physical symptoms, and what tests show.
• Expect assessment of severity (sometimes a CT scan and Haller index) and, for excavatum, heart and lung tests if symptoms suggest it.
• Discuss non-surgical options first, especially bracing for carinatum in a growing young person.
• Understand the NHS funding position: routine funding is limited to very severe physical symptoms, and otherwise an individual funding request may be needed.
• For surgery, tell the team about all medicines, and stop smoking well beforehand.
• Plan several weeks off sport, contact activities and heavy lifting, and arrange help at home.
• For a young person, involve them in the decision and discuss expectations and body image honestly.

What happens

Bracing is non-surgical: a custom brace is fitted and worn for set hours each day over months, with regular reviews to adjust the pressure as the chest reshapes.

Surgery is done under general anaesthetic. In the Nuss procedure, the surgeon makes small cuts at the sides of the chest, guides a curved bar behind the breastbone using a camera, and rotates it to push the chest outward; the bar is fixed and stays in for a few years before a second, smaller operation removes it. In the Ravitch procedure, an open cut is made over the breastbone, the overgrown cartilage is removed or reshaped, and the breastbone is repositioned, sometimes with a temporary support.

Good pain relief is important, as chest wall surgery can be quite painful, often needing an epidural or nerve blocks at first. You are monitored afterwards, with physiotherapy and gradual return to activity.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Pectus surgery is a significant operation, and pain in the first weeks can be considerable, so a clear pain-relief plan matters. The most serious (though rare) risk is injury to the heart or a major vessel when placing a Nuss bar, which is why these operations should be done by surgeons with cardiac and thoracic training and experience. If the concern is mainly cosmetic, weigh the real risks and recovery carefully against the expected benefit. Ask the surgeon how often they do this operation and what their results and complication rates are.

Published figures to discuss

Rates vary with the technique, the patient's age and chest flexibility, and the surgeon's experience. Major complications are uncommon and perioperative death is rare, but pectus surgery is significant and reoperation is sometimes needed. The figures below are cautious and drawn from published series, not guarantees.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery after pectus surgery takes several weeks, with pain a notable feature in the early period. Most people are home within a few days and back to school or work within a few weeks, but contact sport and heavy activity are restricted for longer, and (after a Nuss) a second operation is planned to remove the bar.

• Notable chest pain in the first one to two weeks that gradually improves
• Tiredness and reduced stamina for several weeks
• Stiffness and the need to keep good posture
• A feeling of the bar or hardware under the skin, after the Nuss procedure
• Slow return to full activity and sport over weeks to months

Aftercare

• Take pain relief as prescribed so you can breathe deeply, move and keep good posture.
• Avoid twisting, heavy lifting, contact sport and rough play until your surgeon allows it.
• Keep wounds clean and dry and follow showering advice.
• Do the breathing and posture exercises you are given.
• Watch for wound infection, increasing breathlessness or chest pain and report them.
• For bracing, wear the brace for the agreed hours and check the skin for soreness.
• Attend follow-up to check progress and, for the Nuss bar, plan its later removal.

• Pain relief plan understood and medicines collected
• Time off school, work and sport arranged (several weeks)
• Help at home for the first weeks
• Posture and activity restrictions understood
• Lift home and no-driving advice (for adults) understood
• Clinic and out-of-hours contact numbers saved
• Follow-up appointment booked (and bar-removal plan discussed for Nuss)

Scars and how they heal

The Nuss procedure leaves small scars on each side of the chest where the bar is placed, which usually fade well. The Ravitch procedure leaves a scar across or down the centre of the chest over the breastbone, which is more visible. Bracing leaves no scars but can cause temporary skin marks. Scars are pink and firm at first and settle over months.

⚠ Get urgent help if…

• Severe or worsening chest pain not controlled by your pain relief
• Worsening breathlessness or difficulty breathing
• A fast or irregular heartbeat, or feeling faint
• Fever, or spreading redness, swelling or discharge from a wound
• A sensation that the bar has shifted or moved (after the Nuss procedure)
• Coughing up blood
• For bracing: broken skin, an ulcer or severe soreness under the brace

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means an improved chest shape and, where there were physical symptoms, some relief of breathlessness or chest pressure. The shape change is immediate after surgery, while carinatum bracing corrects gradually over months. Results are generally good in suitable, well-selected people.

No correction is guaranteed to be perfect, symmetrical or permanent, and some people have an incomplete correction or partial recurrence, particularly if treatment is done before growth is finished. For concerns that are mainly about appearance, it is worth being honest with yourself about expectations, because surgery carries real risks and a demanding recovery.

After the Nuss procedure the bar is removed after a few years, by which time the chest has usually remodelled, and results often hold well, though some recurrence is possible. The Ravitch procedure also gives durable results in most people. Carinatum corrected by bracing tends to hold if treatment is completed, but recurrence is more likely if bracing is stopped early or done after growth has finished. Repeat or revision treatment is occasionally needed.

Combining with other procedures

Treatment is usually a single pathway (bracing or surgery), though severe or complex cases may need a combined or staged approach. For the Nuss procedure, bar removal is a planned later step rather than a separate decision. Psychological support for body image can be a valuable part of care, especially for younger patients.

Follow-up & long-term care

You will be followed up to check the correction is holding, the wounds have healed and, for the Nuss procedure, to plan bar removal after a few years. For bracing, regular reviews adjust the brace and track progress. Report severe pain, breathing problems, wound issues or a sense that hardware has moved between appointments.

• Attend follow-up appointments to check the correction is holding
• For the Nuss procedure, plan and attend the later bar-removal operation
• For bracing, wear it for the agreed time and complete the full course
• Keep up posture and breathing exercises during recovery
• Report severe pain, breathing problems or a sense of hardware moving

Revision and secondary surgery reality

• After the Nuss procedure, a planned second operation removes the bar after a few years.
• A Nuss bar can shift or displace and occasionally needs repositioning.
• Some people have an incomplete correction or partial recurrence and may consider revision surgery.
• Recurrence is more likely if treatment is done before growth is finished or if bracing is stopped early.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A clear, written pain-relief plan, recognising that early pain can be considerable.
• Physiotherapy with breathing and posture exercises and a graded return-to-activity plan.
• A named contact and out-of-hours route for severe pain, breathing problems or a sense of bar movement.
• Planned follow-up to check the correction holds, and scheduling of bar removal after the Nuss procedure.
• Access to psychological support for body image, especially for younger patients.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether treatment is bracing or surgery, and which operation (Nuss or Ravitch)
• Surgeon and anaesthetist fees
• Theatre time, length of stay and pain-relief needs (such as an epidural)
• The metal bar and fixation hardware for the Nuss procedure
• A planned second operation to remove the bar (Nuss)
• Assessment scans (such as CT) and heart and lung tests where needed
• Custom brace and review appointments for carinatum bracing

• Surgeon and anaesthetist fees
• Theatre, ward and pain-relief (for example epidural) costs
• The bar and hardware, and the cost of the later bar-removal operation (Nuss)
• Assessment scans and heart and lung tests included or extra
• Length-of-stay assumptions and what happens if you stay longer
• Follow-up appointments and brace reviews where relevant
• What is covered if a complication, revision or incomplete correction occurs

On the NHS? On the NHS, pectus surgery is not routinely funded except for very severe physical symptoms within set criteria; where the concern is mainly cosmetic, an individual funding request through your clinician may be needed, and many people consider private care.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Is my concern mainly about appearance, or do tests show real effects on my heart or lungs?
• Would bracing or a non-surgical option work for me, especially if I am still growing?
• If surgery, would Nuss or Ravitch suit me better, and why?
• How will pain be managed, and how long until I can return to sport and normal activity?
• How often do you perform this operation, and what are your results and complication rates?
• What is the plan and timing for removing the bar, if I have the Nuss procedure?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for pectus correction (sunken or protruding chest)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS England — Clinical commissioning policy: surgery for pectus deformity (all ages) NHS England — Interim policy: pectus surgery for very severe physiological symptoms Royal Brompton & Harefield — Pectus anomaly treatments NHS England — Individual funding requests for specialised services (patient guide) Society for Cardiothoracic Surgery (SCTS)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.