The Ravitch Procedure

What Is the Ravitch Procedure?

The Ravitch procedure is a surgery to correct severe pectus carinatum and pectus excavatum. It's typically used for patients 13 to 22 years old.

What Are Pectus Carinatum and Pectus Excavatum?

Pectus carinatum is a condition in which the breastbone (sternum) juts out. Pectus excavatum is when the breastbone is caved in. These conditions happen because several ribs and the breastbone grow abnormally.

Pectus carinatum and pectus excavatum can be mild or severe. Severe cases may cause problems with the heart and lungs.

What Happens During the Ravitch Procedure?

The Ravitch procedure has several steps:

1. An incision is made across the chest.
2. The rib cartilage is reshaped.
3. In some cases, the surgeon places one or more bars to keep the sternum in its new position. They're removed in about 6–12 months.
4. One or more drains are placed under the skin to drain fluid from the surgery site.
5. A chest tube may be placed to prevent the lung from collapsing.
6. The incision is closed.

In the months after surgery, the cartilage grows and keeps the breastbone in the new position.

What Happens After the Ravitch Procedure?

Your child will need pain medicine and rest after the surgery. He or she will need to stay home from school until prescription pain medicine isn't needed. It may take 6 months or more for your child to return to all activities he or she did before the surgery.

For about 6 weeks after the surgery, your child should:

• Take all medicines as prescribed by the surgeon.
• Do all breathing exercises (this helps prevent infection).
• Walk or do other gentle exercises as recommended by the surgeon.
• Avoid gym class at school.
• Not carry a backpack or other heavy bag.
• Avoid strenuous activity, including running.
• Not drive.
• Ride in the back seat to avoid possible trauma from an air bag.

Your child should not play sports that could cause injury to the chest (such as football, soccer, and baseball) until the surgeon says it's OK.

Check with your surgeon if you have any questions about what activities are safe for your child.

Are There Any Risks From the Ravitch Procedure?

There are risks with any surgery, including bleeding, infection, and problems with anesthesia.

Specific risks for the Ravitch procedure include:

• pain that can last a month or more
• fluid collection under the skin at the surgery site
• fluid around the lung or a collapsed lung
• bars that move out of place
• damage to the heart or lungs during surgery
• pectus excavatum or pectus carinatum that comes back

When Should I Call the Doctor?

Call the doctor if your child has:

• chest pain that's not relieved by pain medicines 
• shortness of breath or trouble breathing
• bulging, swelling, or redness around the incision
• a fever

What Else Should I Know?

Children with pectus carinatum or pectus excavatum can feel self-conscious about the way they look. The Ravitch procedure can improve the way the chest looks and help a child's self-esteem. Although the recovery time can be difficult, most kids are happy with the results.