Treatments›Chest Wall›Abramson Technique

Abramson Technique (Pectus Carinatum)

Removable bar system for Pectus Carinatum (Pigeon Chest)

Procedure Time

45-90 min

Hospital Stay

4-5 nights

Recovery

2-4 weeks

Success Rate

85-90%

In Short

The Abramson technique is a minimally invasive (closed) surgical method for treating Pectus Carinatum (pigeon chest) that reshapes the chest cage without cutting bones. It works on the exact opposite principle of the Nuss procedure.

Core Concept: Outside-In Compression

While in pectus excavatum the chest cage is pushed from inside outward, in the Abramson technique the protruding sternum is corrected by pressing from the outside inward.

Advantages

•Minimal Scarring: No large scar on the front chest wall.
•Tissue Preservation: No bones or cartilage are cut.
•Rapid Recovery: Short surgical time.

The bar remains in place until the chest cage permanently assumes its new shape (typically 2-3 years).

Who Is a Candidate?

Suitable Candidates

✓ Pectus Carinatum (pigeon chest) diagnosis
✓ Adolescent age preferred — chest cage still flexible
✓ Patients who prefer no bone/cartilage cutting (minimally invasive preference)
✓ Those who prefer closed technique over open surgery (Ravitch)

How the Procedure Works

The Abramson procedure is a minimally invasive method for Pectus Carinatum (pigeon chest). Unlike the Nuss procedure, the bar is passed over rather than under the sternum, applying an outside-in compression.

1. Preparation and Positioning

›Anesthesia: The patient is placed under general anesthesia.
›Position: The patient is placed supine (face up), arms extended to both sides.
›Planning: The most prominent point of the sternum is marked preoperatively.

2. Incision and Subcutaneous Tunnel

›Incision: Two bilateral incisions (~3-4 cm each) are made in the mid-axillary line on both sides.
›Tunneling: A tunnel is created from one side to the other, over the pectoral muscles but beneath the subcutaneous tissue. The pleural space is not entered.

3. Stabilizer Placement

›Metal stabilizers are firmly fixed to the ribs on both sides (usually the 3rd or 4th rib) using steel wires or screws. This prevents bar displacement.

4. Bar Shaping and Placement

›The steel bar is bent on the operating table to match the patient's chest structure.
›The shaped bar is passed through the subcutaneous tunnel and placed over the most prominent point of the sternum.

5. Compression and Fixation

›The surgeon manually presses the sternum inward while the bar is locked onto the stabilizers at both ends.
›Symmetry and sternal compression are checked; final adjustments are made.

6. Closure and Post-op Check

›Layers are closed anatomically.
›A chest X-ray is taken to check for pneumothorax or bar positioning errors.

Post-Procedure Key Points

›Bar Retention: The bar typically remains in the body for 2 to 3 years.
›Physical Restrictions: Avoid heavy sports and chest-impact activities for the first 6 months.
›Removal: Performed through similarly small incisions as a day procedure.

Risks & Complications

⚠️ As with any medical procedure, there are risks. The following is evidence-based information.

• Bar displacement
• Skin reaction
• Magnetic field restrictions (MRI)

🧲 MR Conditional — Bar & MRI Compatibility

Most modern bars (especially those made of titanium) are classified as "MR Conditional." This means that the patient can undergo an MRI scan, but only under specific conditions (e.g., maximum 1.5 Tesla, without exceeding a specific SAR [Specific Absorption Rate] limit, and by using specialized sequences). With stainless steel bars, however, avoiding MRI scans until the bar is removed (typically 2 to 3 years) is advised unless it is an emergency, and alternative imaging modalities such as CT (Computed Tomography) are preferred.

Recovery Process

Day 0-4

Procedure, discharge

Month 1

Follow-up

Month 3

Follow-up

Month 6

Follow-up

Month 12

Follow-up

Year 3

Bar removal decision

Tests Required for Evaluation

Upload the following documents in your Free Evaluation form for remote candidacy assessment:

✓ Chest CT
✓ Echocardiography
✓ PFT (Pulmonary Function Test)

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Compare Your Options

Abramson Technique vs. Open Ravitch Method

Criterion	Abramson Technique (Minimally Invasive)	Open Ravitch Method (Conventional)
Surgical Time	Shorter. 45-90 minutes; no bone cutting required.	Longer. 3-5 hours; cartilage removal and sternum reshaping is time-consuming.
Pain Level	Low / Moderate. No bone cutting; bar pressure may cause initial discomfort.	High. Extensive tissue dissection and cartilage resection.
Mobilization	Fast. Patient typically mobilizes within 24 hours.	Slow. Large incision and drains extend recovery.
Cosmetic Outcome	High. No large scar on chest front; only small side incisions.	Moderate. Permanent large scar on front chest wall.
Recurrence Risk	Low. Bar supports chest for 2-3 years for full adaptation.	Low / Moderate. May rarely revert without supporting material.

Selection Criteria

Surgical Trauma: Ravitch removes deformed costal cartilages and sometimes cuts the sternum. Abramson preserves anatomy — only a metal bar remodels the sternum.

Bar Factor: The main disadvantage of Abramson is that a bar remains in the body for 2-3 years requiring a second small procedure for removal. Ravitch is generally single-stage.

Age Factor: Abramson is highly successful in adolescence when chest flexibility is high. Ravitch remains an option for older patients with fully calcified cartilage.

In current surgical practice, the Abramson technique is the first-choice method. Ravitch is reserved for asymmetric and severely calcified deformities.

Scientific References

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