Pectus Consultations | Nuss Procedure | Pediatric Surgical Associates

About Consultations

Our goal with our consultation is to provide the best pediatric healthcare without unnecessary tests and medicines.
We seek to attain optimal mental, physical, and social health and well-being for all infants, children, and adolescents.
We are successful when we make your experience a personal one. We will treat your child like we treat our very own. We want to work with parents and help you raise a happy, healthy child.
We believe in open and direct communications and take the time to understand the child’s health, illness and pediatric needs.
Our goal is to make a difference in the lives of children by providing quality health care in an environment built on knowledge, innovation, integrity, and fun!

01. New Patients

Please plan to arrive at least 15-20 minutes prior to your appointment. The traffic and parking can sometimes be difficult and take more time than anticipated.
Please take this into account when you leave for your visit. Parking is available in our building’s lot.

02. Easy Communication

When you arrive to the office in the building, you will first need to check in at the front desk. You will be asked to complete a demographic information sheet this will help the billing staff to correctly bill your insurance company. It is often helpful to complete these forms prior to your visit – please ask us over the phone to send them to you in advance.

03. You or Your Child's Exam

Once you are called into the exam room, the Doctor will then review your child’s medical history in detail and a physical exam will be performed on your child to obtain a correct diagnosis.
If surgery is recommended, we will go over next steps at that time.

Still Have Questions?

Look through the answers to the most popular questions.

The Condition: Pectus Excavatum
Pectus excavatum is a depression of the sternum and anterior chest. The deformity is sometimes referred to as sunken or funnel chest and may appear as though someone has punched in the chest. The severity of the depression ranges from mild to severe. Mild cases may respond to an exercise and posture program, whereas more severe cases require surgical correction.
Pectus excavatum tends to run in families and is often present at birth. The deformity usually progresses as the child grows, often showing dramatic deterioration during the pubertal growth spurt.
When To Seek Surgical Correction
Surgical correction of pectus excavatum is done for medical reasons. Children with moderate to severe defects often experience shortness of breath, exercise intolerance and chest pain. These are the results of compression and displacement of the heart and secondary lung compression.
Preoperative Screening And Evaluations
After a complete health history, a thorough physical exam, chest measurements, and photographs, children whose condition is considered severe enough to warrant surgery are sent for further evaluation of their cardiac status, pulmonary function, and a CT scan. These studies help determine whether the patient fulfills the criteria for surgery, since not every child requires surgical correction.
What Is The Optimal Age To Get The Nuss Procedure?
The operation is easier and the recovery time faster in children who are preadolescent, because their bones and cartilage are more flexible. However, there has been an increase in the number of teenagers undergoing the procedure and results are equally good in older patients up to the mid-twenties.
Long-Term Results
Long-term follow-up (over 15 years) shows the Nuss Procedure provides excellent results with less than 5% recurrence of the deformity after the bar is removed.
The Operation
The operation for correction starts with general anesthesia and the placement of an epidural catheter for the management of pain after the operation. Two lateral incisions are made on either side of the chest for insertion of a curved steel bar under the sternum. A separate, small lateral incision is made to allow for a thorascope (small camera) for direct visualization as the bar is passed under the sternum. The bar is individually curved for each patient. The bar is used to pop out the depression.
It is then fixed to the ribs on either side and the incisions are closed and dressed. A small steel, grooved plate may be used at the end of the bar to help stabilize and fix the bar to the rib. The bar is not visible from the outside and stays in place for a minimum of two years. When it is time, the bar is removed as an outpatient procedure.
Bar Removal
The pectus support bar is removed between two to four years after insertion on an outpatient basis. The procedure is done under general anesthesia and in over 160 patients who have had their bars removed there were no complications. Patients were able to leave the hospital within one to two hours after bar removal. Patients who reside more than one hour from the hospital are expected to spend their first night in town.
Recovery And Return To Normal Activity
The immediate recovery time in the hospital is 4-5 days. Attention is paid to postoperative pain management, encouragement to breathe deeply, assistance with movement (so as not to dislodge the bar), and patient/parent education.
After discharge, the patient is expected to slowly resume normal, but restricted, activity. Most children are able to return to school in two to three weeks, with exercise restrictions for six weeks (i.e. no physical education, no heavy lifting, etc.). Once fully recovered they may return to regular activity.