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Chest wall conditions

Chest wall conditions

patient hiking

The team of specialists at Shriners Hospitals for Children — Northern California treats chest wall malformations of all degrees. All treatment decisions are guided by internationally recognized pediatric surgeons who consider minimally invasive options for each patient. All care is delivered in our regional pediatric medical center, where the medical team works collaboratively to ensure that children benefit from the finest, most advanced pediatric medical care.

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. 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, experiencing 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.

Chest wall conditions treated include:

  • Pectus carinatum (raised chest)
  • Pectus excavatum (sunken chest)
  • Poland’s syndrome

Schedule an Appointment

Shriners Hospitals for Children — Northern California

Phone: 916-453-2191

All care is provided regardless of a
family’s ability to pay.

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.

Treatment options


For patients with pectus carinatum, who are still growing, compression bracing is an effective therapy to correct the malformation.

Ravitch procedure

Ravitch procedure is done through a horizontal incision across the middle chest to correct pectus excavatum. In this repair the abnormal costal cartilages are removed, preserving the lining of cartilage, thus allowing the sternum to move forward in a more normal position. This procedure takes approximately four to six hours. In certain patients, an osteotomy (a break) in the sternum is done to allow the sternum to be positioned forward. In addition, to keep the sternum elevated in the desired position after the removal of the cartilages and the osteotomy, a temporary metal chest strut (bar) may need to be placed.

Nuss procedure

The Nuss procedure is a minimally invasive repair with a metal pectus bar for pectus excavatum. The Nuss procedure involves bending a stainless bar to fit the chest. 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, pushing the sternum forward into the new position. The ends of the bar are secured to the chest wall. The Nuss procedure takes approximately two hours and removal takes one hour.

The medical team

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

Diana L. Farmer, M.D., FACS, FRCS
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


Medical research focuses on clinical and technological innovation. Shinjiro Hirose, M.D., who also holds a degree in engineering, is researching the use of telerobotics in medicine. Gary Raff, M.D., is leading a groundbreaking study of a device that uses magnets to correct sunken chest, the most common congenital chest-wall abnormality. Magnets are employed in a minimally-invasive procedure that allows patients to return home the day after the procedure with minimal discomfort.