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Pectus excavatum Nuss procedure
Condition Guide

Pectus excavatum
The Nuss procedure — minimally invasive sunken-chest repair

Pectus excavatum is when the breastbone grows inward, giving the chest a sunken or “caved-in” look. It’s the most common chest-wall difference and can affect confidence and, in deeper cases, breathing or the heart. The Nuss procedure reshapes the chest using a hidden support bar — Dr. Irshad introduced this operation to William Osler Health System.

Dr. Irshad specializes in pectus excavatum surgery for adults. Children and adolescents are referred to a paediatric (children’s) hospital, where specialist teams care for younger patients.

Nuss procedure
Procedure
3–5 days
Hospital stay
Keyhole
Minimally invasive
2–3 years
Bar in place

What is pectus excavatum?

The cartilage that joins the ribs to the breastbone grows unevenly, pulling the breastbone inward. It’s usually noticed in the teenage years during a growth spurt. Most cases are about appearance, but deeper ones can press on the heart and lungs.

Signs & symptoms

  • A sunken-looking chest
  • Self-consciousness about appearance
  • Shortness of breath or tiring quickly with exercise
  • Chest discomfort
  • In deeper cases, the heart can be pushed to one side

Pectus excavatum is usually first noticed in the teenage years. It’s worth getting assessed if it’s affecting breathing or exercise, causing chest discomfort, or affecting confidence.

How it’s assessed

  • A physical exam
  • A CT or MRI to measure the depth (the Haller Index)
  • Sometimes heart and lung tests to check for any effect on function

Treatment options

  • The Nuss procedure — a curved bar placed behind the breastbone to push it out
  • The vacuum bell — a non-surgical suction device that gradually lifts the chest, useful for milder cases and younger patients
  • Bracing or physiotherapy for milder cases
  • The bar stays 2–3 years, then is removed in a short day surgery
Patient tool
Estimate your Haller Index at home

Take two simple chest measurements and see roughly where your result falls compared with reference ranges. An educational estimate — not a diagnosis.

Open tool →
Dr. Irshad’s approach

The Nuss procedure

Through two small cuts on the sides of the chest, a curved metal bar is guided behind the breastbone and turned to gently lift it into a normal position — like braces for the chest. No bones are cut.

The bar stays for 2–3 years while the chest reshapes, then is removed in a short day surgery. Dr. Irshad brought this procedure to William Osler Health System.

Your recovery, step by step

Hospital

3–5 days; pain is managed with an epidural or IV medication at first.

Weeks 1–6

Restricted activity and no contact sports; back to work or studies in 2–3 weeks.

3 months

Return to most sports and activities.

2–3 years

The bar is removed as a day surgery; the correction is permanent.

Long term

Most patients are very satisfied with the cosmetic and functional result, with no restrictions after the bar is removed.

Download recovery guide (PDF)A printable guide to take home.

Common questions

Does Dr. Irshad treat children, or only adults?
Dr. Irshad specializes in pectus excavatum surgery for adults. Children and adolescents are referred to a paediatric (children’s) hospital, where specialist teams are set up to care for younger patients. The Nuss procedure gives excellent results in adults.
Will the correction last after the bar is removed?
Yes. The bar holds the chest in its new shape for 2–3 years while the cartilage and bone reshape and set. Once that has happened, the bar is removed and the correction is permanent for the large majority of patients, with no implant left behind.
How is pain managed after surgery?
Lifting the breastbone can be uncomfortable at first, so pain is managed actively. This usually starts with an epidural or IV medication in the first days after surgery, then moves to oral painkillers as you improve. The team adjusts your pain control to keep you comfortable while you recover.
Will the bar set off metal detectors?
It can. Patients get a medical-alert card confirming the implant. The bar is generally MRI-safe, but always let the imaging team know about it and check with Dr. Irshad before any MRI. After the bar is removed, no metal remains.
Is this covered by OHIP?
The Nuss procedure is generally covered when the deformity is significant or is causing symptoms by compressing the heart or lungs, assessed by CT using the Haller Index. Dr. Irshad reviews your imaging and confirms coverage at your consultation.

Preparing for your surgery at William Osler

Your operation takes place at William Osler Health System (Brampton Civic Hospital). These are the hospital’s general instructions for getting ready, the day itself, and afterwards — always follow any specific advice Dr. Irshad gives you. Full details are on the Osler Surgical Services page.

Before your surgery
  • Do not eat anything (including gum) after midnight the night before. Unless told otherwise, you may have clear fluids — water, pulp-free juice, black coffee or tea — up to 2 hours before.
  • No alcohol, smoking, or marijuana for 24 hours before surgery.
  • Shower the evening before and the morning of surgery (with chlorhexidine soap if you have it). Skip lotion, perfume, makeup and nail polish.
  • Bring your OHIP card and photo ID, all your medications in their original containers (inhalers, insulin, supplements), and your CPAP machine if you use one.
  • Arrange a responsible adult to drive you home — a taxi, Uber or Lyft does not count, and surgery may be cancelled without one.
  • Leave jewellery, money and valuables at home.
The day of your surgery
Arrive about 2 hours before your scheduled time. Register at the central registration desk in the main lobby at Brampton Civic Hospital (2100 Bovaird Drive East), then go to the Day Surgery area. Staff will help you change, check your vitals, confirm the details from your pre-anaesthesia visit, and start an IV before you go to the operating room. Your family member can wait in the surgery waiting area.
After your surgery
You’ll wake up in the Post-Anaesthesia Care Unit, then move to Day Surgery or an inpatient room (or the Intensive Care Unit if you need closer monitoring). For the first 24 hours after the anaesthetic, have an adult with you, do not drive or operate machinery, avoid alcohol, and hold off on big decisions. A follow-up appointment is booked before you leave. Learn more about discharge and pain management.
The pre-anaesthesia clinic
Before your operation you’ll get a call from the pre-anaesthesia clinic for an education call or an in-person visit, where the team reviews your health, your medications and your anaesthetic plan.

Medically reviewed by Dr. Kashif Irshad, MD, MSc, FRCSC · Last updated July 2026

A referral from your family doctor or specialist is all that’s needed to be seen by Dr. Irshad. Find the referral forms and clinic details below.

Referral information →