Meet Dr.Dr. Julia Chen at Austin Pediatric Surgery! Learn more about how we're serving Central Texas. Julia Chen, MD, FACS Meet Dr. Chen Dr. Chen is a board certified pediatric surgeon with an interest in trauma, congenital diaphragmatic hernias and ECMO. She is an advocate for advancing minimally invasive techniques in surgical care of children and injury prevention in the community. She lives in Austin with her husband and children and loves exploring the local food scene! My Journey to Pediatric Surgery "Pediatric surgery combines my interest in service to the community by providing high level surgical and trauma care for all children and perfecting the technical precision it takes to perform complex procedures in our smallest patients. I believe in a family centered approach to care and that prioritizing healthy children and our most vulnerable patients has the ability to uplift an entire community." My Clinical Focus "What drew me to pediatric surgery is the breadth of procedures that we perform, from "lumps and bumps" to coordinating care of patients with complex congenital disorders. I am especially interested in expanding minimally invasive approaches to treatment as well as ECMO and management of congenital diaphragmatic hernias." Services I Provide • Pediatric Trauma Care • Minimally Invasive (Laparoscopic/Thoracoscopic) Surgery • Surgical care of the neonate • Pediatric Hernia Surgery • Removal of Pediatric Tumors & Soft Tissue Masses • Pediatric Gastrointestinal Surgery • Extracorporeal Membrane Oxygenation (ECMO) • Pilonidal Disease Degree & Training Medical School Icahn School of Medicine at the Mount Sinai Medical Center Residency Icahn School of Medicine at the Mount Sinai Medical Center Fellowship Bloomberg Children's Center at Johns Hopkins Medical Center Board Certification American Board of Pediatric Surgery American Board of Surgery Memberships • American Academy of Pediatrics • American College of Surgeons • American Pediatric Surgical Association • Pediatric Trauma Society Providing trusted care when it matters most GET IN TOUCH

Access important resources to prepare for your child’s surgical journey. Find details about forms, pre-operative planning, financial arrangements and post-surgery care at Austin Pediatric Surgery. Patient Info Patient Forms Patient Resources Before Surgery Insurance & Billing After Surgery Medical Records Patient Forms In an effort to make each appointment go as smoothly as possible, we ask that you complete relevant patient forms prior to your child’s visit. To save time in the office, feel free to print and complete the patient forms and bring them with you to the appointment. If you have any questions about the information on these forms or about your appointment in general, please call (512) 708-1234. Print New Patient Forms Consent Without Guardian Formas del Pacientes- Español Descargue los siguientes formularios, complételos y tráigalos a la oficina para su cita. Formas del Pacient Consentimiento para Tratamiento en Ausencia del Tutor Legal Before Surgery We’re here to ensure your child’s surgery is as smooth and stress-free as possible. Preparing together can help ease anxieties and create a positive experience. Prior to your child’s surgery, please fill out any required patient forms . Steps to Prepare: Ask Questions : Speak with your physician or hospital staff ahead of time to address any questions you might have. Be Honest: Use simple, age-appropriate explanations with your child about the procedure and what to expect. Encourage Play : Let your child explore with medical toys or dolls to build familiarity with their procedure, express their feelings and feel more in control. Pack Comfort Items: Include favorite toys, books or a cozy blanket to help them feel at ease. Storytime Prep: Read books like Curious George Goes to the Hospital or other relevant books and stories to help your child feel more at ease. For more information about our surgical facilities, visit: Dell Children’s Medical Center Dell Children's Medical Center - North Campus Strictly Pediatrics Surgery Center Pre-Operative Tours at Dell Children's Medical Center Prepare your child for surgery with a hands-on pre-operative tour led by a Child Life Specialist. These tours help children and families understand what to expect, reducing stress and promoting confidence. Your child will get to see medical equipment, explore key areas like the operating and recovery rooms, and learn about the surgery process in a kid-friendly way. Siblings are welcome to join, making it a family experience. For dates, times and reservations, call the Surgery Child Life Specialist at (512) 324-0146. After Surgery Your child’s recovery is our priority, and we’re here to help every step of the way. If you have any questions or concerns about post-operative care, we encourage you to contact us directly. Our team is available to answer your questions and ensure your child’s recovery goes as smoothly as possible. For assistance, please call us anytime at (512) 708-1234 . We’re here to provide the guidance and support you need. Patient Resources For additional information regarding our professional associations, resources, and partners, please see the links provided below. American Pediatric Surgical Association American Pediatric Surgical Association Parent Resources American Academy of Pediatrics What is a Pediatric Surgeon Dell Children’s Medical Center Strictly Pediatrics Surgery Center Insurance & Billing At Austin Pediatric Surgery, we are committed to ensuring that every child receives the surgical care they need, regardless of insurance status. We accept all major insurance plans and encourage families to contact us with any questions about coverage or financial arrangements. Our team works closely with families to make the process as smooth as possible and will assist in finding solutions that fit your situation. If you have questions, please call our office at (512) 708-1234 to speak with our financial department. PAY MY BILL Medical Records Request All patient health care information at Austin Pediatric Surgery is strictly confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law). Release Form To receive a copy of your child’s health information, an authorization to release medical information must be signed and dated by the parent or legal guardian. A fee of $25.00 will be assessed to cover the cost of copying and sending your record. If the records are being faxed or mailed to another medical facility, there is no charge. Medical Records Release Form Submitting your Form Completed authorization forms may be submitted to Austin Pediatric Surgery by mail, in person or by fax. Mailing address: Austin Pediatric Surgery 1301 Barbara Jordan Blvd Suite 400 Austin, TX 78723 Fax number: (512) 708-4567

Meet Dr.Michael Josephs at Austin Pediatric Surgery! Learn more about how we're serving Central Texas. Michael Josephs, MD, FACS Meet Dr. Josephs Dr. Josephs relocated to Austin from the East Coast in 2002, drawn by the opportunity to provide exceptional surgical care to the children of Central Texas. Beyond the state-of-the-art healthcare environment, he was inspired by Austin’s vibrant culture, offering endless outdoor adventures in the Hill Country and the energy of its renowned live music scene. My Journey to Pediatric Surgery "I was introduced to surgery at the age of 5, watching my father operate on feet in his podiatry office. I was instantly compelled to continue in the spirit of helping people with surgery, although my interests extended beyond the ground level. By the age of 10 I had memorized the human anatomy, and my decision to be a surgeon never changed. During residency training I was in awe when I understood the impact that operating on a child provided to families. I can imagine no greater responsibility than taking care of someone's child, and I am honored and humbled to make an impact on so many lives." My Clinical Focus "My primary focus is to provide comprehensive care to children who require surgery, understanding that the families are my patients as well. Whenever possible, my operations are performed minimally invasively in order to reduce pain and complications. Additionally I have been working to develop new instruments and devices which will advance the care of children who undergo surgery. I also enjoy teaching new doctors in training and contributing to the future of our healthcare." Services I Provide • Neonatal Surgery • Removal of Lumps and Bumps • Inguinal and Umbilical Hernias • Pectus Excavatum/Carinatum Program • Removal of Chest and Abdominal Tumors • Complex Laparoscopic Surgery • Complex Thoracoscopic Surgery • Correction of Undescended Testes • Appendectomy • Circumcision • Complex Hepatobiliary Surgery Degree & Training Medical School Georgetown University School of Medicine Residency University of Florida College of Medicine Fellowship Cincinnati Children's Hospital Medical Center Board Certification American Board of Pediatric Surgery American Board of Surgery Memberships • American Academy of Pediatrics • American College of Surgeons • American Pediatric Surgical Association • Children's Oncology Group • International Pediatric Endosurgery Group Providing trusted care when it matters most GET IN TOUCH

Expert surgical care for CPAM, thoracic tumors and other lung conditions using advanced minimally invasive techniques. Complex Thoracic Surgery CONGENITAL LUNG LESIONS THORACIC CYSTS & TUMORS THYMOMAS & MYASTHENIA GRAVIS PNEUMOTHORAX Our pediatric surgeons are highly skilled in minimally invasive and open thoracic surgeries to treat various conditions affecting the chest cavity. These include congenital abnormalities, cysts, tumors, and issues that impact breathing or heart function. Our surgeons specialize in Video-Assisted Thoracoscopic Surgery (VATS), a minimally invasive approach using small incisions to reduce scarring and recovery time. Most children recover quickly, returning home within 1-3 days and resuming regular activities soon after. Congenital Lung Lesions What is it? An abnormal area of the lung that occurs during fetal development that may contain cysts or poorly functioning tissue, usually diagnosed before birth by fetal ultrasound. Variations Congenital Pulmonary Airway Malformations (CPAMs) : Abnormal lung tissue that may include cysts. Bronchopulmonary Sequestrations (BPS) : Non-functioning lung tissue with its own blood supply, separate from the normal lung. Congenital Lobar Emphysema (CLE) : Overinflation of one lung lobe due to abnormal airway development. Treatment Surgery to remove the affected lung portion during infancy to prevent complications like infections or breathing issues. Thoracic Cysts & Tumors Examples Bronchogenic cysts, neurogenic tumors, teratomas, and lymphomas. Treatment Surgical biopsy or removal, often performed minimally invasively. Thymomas & Myasthenia Gravis What is it? Abnormal thymus growth or diseases like myasthenia gravis, which cause muscle weakness. Treatment Surgery to remove the tumor or thymus to alleviate symptoms. Pneumothorax What is it? A collapsed lung caused by air leakage, leading to chest pain and difficulty breathing. Treatment Chest tube placement and possibly surgery to remove abnormal lung tissue that is predisposed to collapsing.

Trusted trauma surgeons at Dell Children’s Medical Center deliver expert care for severe pediatric injuries with compassion and advanced techniques. Pediatric Trauma Pediatric trauma involves severe, life-threatening injuries that require immediate hospitalization and often emergency surgery. Our team at Austin Pediatric Surgery is highly skilled in managing complex trauma cases with expertise and compassion. Expert Pediatric Trauma Care We provide trauma care at Dell Children’s Medical Center, Central Texas’s only Level 1 Pediatric Trauma Center, the highest designation for trauma care. This ensures our surgeons are fully equipped to handle the most severe injuries, offering the best outcomes for children in critical situations. Expertise you can Trust Our trauma program addresses a wide range of injuries, including: Severe fractures and orthopedic trauma Head and spinal cord injuries Internal injuries requiring surgical intervention Burns Complex lacerations & more Comprehensive, Family-Centered Care We know that trauma impacts the whole family, not just the injured child. Our team prioritizes emotional support alongside expert medical care. With access to Child Life Specialists, families receive guidance and reassurance during every step of the recovery journey. Advanced Facilities and Multidisciplinary Approach Dell Children’s Medical Center is equipped with cutting-edge diagnostics, surgical capabilities, and rehabilitation services, ensuring seamless, comprehensive care from the moment your child arrives. Our multidisciplinary team collaborates to tailor treatment plans that address both immediate and long-term recovery needs. We're Here When You Need Us Trauma can be unpredictable, but our commitment to exceptional care never wavers. For more information about our pediatric trauma program or to speak with a member of our team, please contact us anytime. To learn more, visit the Dell Children’s Emergency and Trauma Center page.

Specialized care for ovarian masses and cysts using minimally invasive techniques for a safer, faster recovery. Ovarian Masses & Cysts Ovarian masses and cysts can occur in children and adolescents, often requiring specialized diagnosis and treatment. At Austin Pediatric Surgery, our team is trained to provide expert care specialized for pediatric gynecological issues, using advanced diagnostic tools and minimally invasive surgical techniques to ensure the best outcomes for your child. What are Ovarian Masses and Cysts? Ovarian Cysts: Fluid-filled sacs that form on or within an ovary. Most are benign and resolve on their own, but some may require surgical intervention. Ovarian Masses: Abnormal growths in or around the ovaries, which may be benign or, in rare cases, malignant. Signs and Symptoms Abdominal pain or bloating Changes in menstrual patterns Nausea or vomiting Feeling of fullness or pressure in the abdomen If your child exhibits any of these symptoms, contact your pediatrician or a specialist for evaluation. Diagnosis Ultrasound: The primary tool for identifying ovarian cysts or masses. MRI or CT: Used when detailed anatomical information is needed. Blood Tests: May be conducted to evaluate for hormonal imbalances or tumor markers. Treatment Options Depending on the nature of the ovarian mass your surgeon will work with you to create an appropriate surgical plan using minimally invasive techniques, when possible, with the priority of treating the disease and preserving future fertility. Contact Austin Pediatric Surgery for more information about our gynecologic services or to schedule a consultation. We’re here to provide compassionate, expert care for your child’s needs.

Meet Dr.Erich Grethel at Austin Pediatric Surgery! Learn more about how we're serving Central Texas. Erich Grethel, MD, FACS Meet Dr. Grethel Dedicated to improving pediatric surgical care, Dr. Grethel serves as the division chief of pediatric surgery as well as the surgeon champion for the Dell Pediatric NSQIP team, focusing on enhancing quality and outcomes for young patients. Dr. Grethel also leads the chest wall program at APS. My Journey to Pediatric Surgery "My outstanding mentors are what drew me to medicine and, eventually, pediatric surgery. From an amazing anatomy class in high school where I had hands-on experience with the human body, through medical school and then surgery training, where I had brilliant and inspirational role models in both general and pediatric surgery. These teachers loved medicine and pediatric surgery, and I could not help but share that joy. The beauty of pediatric surgery is that it combines the awe and fascination of surgery of all parts of the body with the opportunity to make a difference in the lives of kids and their families." My Clinical Focus "I love that as a pediatric surgeon, I treat a variety of different conditions, from hernias and lumps and bumps, to more complex problems, such as birth defects like diaphragm hernias and intestinal malformations. I counsel families, consult with maternal-fetal-medicine specialists, and care for newborns who may need surgery around the time of birth. I care for children who have forms of cancer that may be treatable with surgical therapies. I am the director of the pectus chest wall program at Dell Children’s. I also measure quality and outcomes as surgeon champion of Dell Children's pediatric arm of the National Surgical Quality Improvement Program." Services I Provide • Prenatal Counseling for Fetal Conditions • Inguinal Hernia and Hydrocele Repair • Complex Neonatal Surgery • Pectus Excavatum/Carinatum Program • Management of Traumatic Injuries • Surgical Urgent Care • Lumps and Bumps of the Head and Neck Degree & Training Medical School Harvard Medical School Residency The University of California, San Francisco Medical Center Fellowship Texas Children's Hospital Fetal Surgery: University of California, San Francisco Medical Center Board Certification American Board of Pediatric Surgery American Board of Surgery Memberships • American Academy of Pediatrics • American College of Surgeons • American Pediatric Surgical Association Providing trusted care when it matters most GET IN TOUCH

Meet Dr.Aaron Beckwith at Austin Pediatric Surgery! Learn more about how we're serving Central Texas. Aaron Beckwith, MD Meet Dr. Beckwith Dr. Beckwith is a proud Southerner and a dedicated family person, married with a daughter and three rescue dogs. He had the privilege to serve in the United States Marine Corps and Air Force. He’s passionate about staying active, whether through outdoor adventures with his family or pursuing fitness goals. My Journey to Pediatric Surgery "My passion for healthcare is deeply rooted in my upbringing and life experiences. Inspired by my family’s volunteer work in my childhood community, I developed a strong sense of compassion and service early on. Growing up on a farm in Tennessee, I learned the value of hard work and problem-solving while fixing things. Through my military service, including deployments to Iraq and Syria, it reinforced my commitment to helping others. My life experiences have shaped my desire to make a meaningful impact in the healthcare field through pediatric surgery." My Clinical Focus “Variety is the spice of life” perfectly describes my clinical focus in pediatric surgery, which spans care for newborns to adults and encompasses everything from straightforward procedures to highly complex operations. I take great pride in performing minimally invasive surgeries, appreciating the benefits these techniques offer. I have additional interests including oncology, extracorporeal membrane oxygenation (ECMO), congenital diaphragmatic hernia (CDH), and pectus wall abnormalities. I am deeply committed to delivering the best possible outcomes for my patients and their families. " Services I Provide • Pediatric Hernia Surgery • Extracorporeal Membrane Oxygenation (ECMO) • Pectus Excavatum/Carinatum Treatment • Pediatric Trauma Care • Minimally Invasive Surgery (Laparoscopic/ Thoracoscopic) • Pediatric Cancer Surgery • Surgical care of the neonate • Pediatric Gastrointestinal Surgery Degree & Training Medical School Quillen College of Medicine - East Tennessee State University Residency University of Cincinnati Fellowship University of Michigan Board Certification American Board of Pediatric Surgery American Board of Surgery Memberships • American College of Surgeons • American Pediatric Surgical Association • Alpha Omega Alpha • Gold Humanism Honor Society Providing trusted care when it matters most GET IN TOUCH

Learn about Austin Pediatric Surgery, where skilled pediatric surgeons provide state-of-the-art care. Our mission: expert surgical care with a compassionate touch. About Us For over four decades, Austin Pediatric Surgery has been here for Central Texas families. We are honored to partner with you in caring for your child and ensuring they receive the compassionate, expert care they deserve. Caring for Central Texas Families Since 1972 Austin Pediatric Surgery was founded in 1972 with a mission to provide expert surgical care to children in the Central Texas community. Over the decades, our team has grown into a group of highly skilled pediatric surgeons and care providers, united by a shared commitment to compassionate, state-of-the-art care. From the early days of our practice to today, we’ve proudly served as a dedicated pediatric surgical group in the greater Austin area, helping families navigate their child’s surgical needs with confidence and comfort. Our Mission & Vision At Austin Pediatric Surgery, our mission is to deliver the highest level of cutting-edge pediatric surgical care to families and children across Central Texas. We envision a future where every child has access to compassionate, multidisciplinary care that supports their health, growth and well-being. A Legacy of Excellence & Leadership As the region’s leading pediatric surgical group, we’ve achieved numerous milestones, including the development of world-class programs for chest wall and colorectal surgery, as well as maintaining the only Level 1 Pediatric Trauma Center in Central Texas. Our team’s expertise, coupled with advanced technology and innovative techniques, ensures your child receives the best possible care. MEET YOUR TEAM Our Core Values Gold Standard Care We are committed to excellence, providing exceptional care to all children, regardless of socioeconomic status or insurance coverage. Family-Centered We work closely with families to ensure they feel supported and informed every step of the way. Team Approach Our surgeons, staff and specialists work seamlessly together to deliver comprehensive, individualized care. Why Families Trust Us From the moment you walk through our doors, our goal is to make your experience as stress-free and comfortable as possible. Whether your child is undergoing a routine procedure or requires specialized care, you can trust that our skilled team will treat them with kindness, respect and the highest level of expertise. Where Excellence Meets Compassion MEET YOUR TEAM

Meet Dr.Jessica Naiditch at Austin Pediatric Surgery! Learn more about how we're serving Central Texas. Jessica Naiditch, MD, FACS Meet Dr. Naiditch Dr. Naiditch is a board-certified pediatric surgeon specializing in the surgical management of inflammatory bowel disease, trauma, and oncology. She leads the Austin Pediatric Surgery Inflammatory Bowel Disease Team and serves as the Trauma Medical Director at Dell Children’s Medical Center. She has published extensively on topics such as lung biopsy techniques, drug resistance in neuroblastoma, intussusception, cloacal exstrophy and tracheal remnants, reflecting her dedication to improving outcomes for pediatric patients. My Journey to Pediatric Surgery "I cherish the privilege to help children. My motivation throughout medical school and residency has been my drive to become a pediatric surgeon. I am driven by the potential for cure during an operation. At the same time, I am also deeply humbled by parents who trust us with the lives of their children." My Clinical Focus "As a pediatric surgeon, I have experience in all aspects of neonatal and pediatric surgery. Minimally invasive surgery is integrated into my practice as much as possible. My strong interest in surgical oncology and inflammatory bowel disease keeps me engaged with my medical colleagues to ensure comprehensive multidisciplinary care. As the Trauma Medical Director at Dell Children’s Medical Center, I work to ensure the injured children in Austin received the best care possible. I provide surgical care for children with congenital anomalies. I also provide care for children with surgical issues involving the neck, chest and abdomen." Services I Provide • Pediatric Trauma Care • Removal of Pediatric Tumors • Pediatric Chest Surgery • Pediatric Hernia and Hydrocele Repair • Neonatal Surgery • Minimally Invasive Surgery • Inflammatory Bowel Disease Degree & Training Medical School University of Pittsburgh School of Medicine Residency McGaw Medical Center at Northwestern University Feinberg School of Medicine Fellowship University of Texas Southwestern Medical Center Board Certification American Board of Pediatric Surgery American Board of Surgery Memberships • American Academy of Pediatrics • American College of Surgeons • American Pediatric Surgical Association Providing trusted care when it matters most GET IN TOUCH

Compassionate surgical care for imperforate anus and other colorectal disease and anorectal conditions, helping children thrive with expert solutions. Complex Congenital Colorectal Disease ANORECTAL MALFORMATIONS BOWEL MANAGEMENT At Austin Pediatric Surgery, we specialize in the comprehensive care of children with complex colorectal and bowel conditions. From congenital issues like anorectal malformations and Hirschsprung Disease to chronic constipation and fecal incontinence, our expert team offers individualized treatment plans designed to improve your child’s quality of life. We combine advanced surgical techniques with compassionate, family-centered care, guiding you through every step—from diagnosis and treatment to recovery and long-term bowel management. Our goal is to ensure your child thrives with predictable bowel function, enhanced self-esteem, and overall well-being. Anorectal Malformations Anorectal malformations (Imperforate Anus) are congenital defects where the anus is absent or improperly formed, preventing normal stool passage. This condition occurs in about 1 in 5,000 births. Types of Anorectal Malformations Absent Anal Opening: No opening for stool to pass. Misplaced or Small Anal Opening: Located incorrectly or too small. Fistula Connections: Abnormal connections between the rectum and the urinary system or vagina. Cloaca (Females): A single opening for the intestine, urethra, and vagina. Diagnosis Diagnosis is made through physical exams at birth and confirmed with additional tests for associated anomalies: Ultrasound: Evaluates kidneys. X-Ray: Checks intestine and spine. Echocardiogram: Assesses heart function. Treatment Low Rectum or Abnormal Opening Single surgery (anoplasty) moves or creates the anal opening. High Rectum with No Opening Three-Staged Surgery: Colostomy: Creates a stoma for stool passage. Neo-Anus Creation: Positions the rectum correctly and repairs fistulas. Colostomy Closure: Restores normal stool passage. Post-Surgical Care and Recovery Hospital Stay: Discharge occurs once feeding, bowel function, and pain are well-managed. Home Care: Includes ostomy care, preventing diaper rash, and managing constipation. Long-Term Management: Children with high rectal defects may require a bowel management program for proper function. Austin Pediatric Surgery is here to guide you through every step, ensuring the best outcomes for your child’s care and recovery. Contact us for support or consultation. Bowel Management Our Bowel Management Program is for children with constipation and/or fecal incontinence. We work with children and families to achieve a goal of predictable bowel movements to improve quality of life. This program is designed to avoid bowel accidents and diaper dependence, which can lead to remaining clean and improved self-esteem. We offer daily feedback via email or a phone call to achieve the individualized goals discussed at the initial meeting. Fecal incontinence can be a result of congenital conditions, constipation, or issues with muscle weakness or injury. Symptoms of this can be mild leakage of stool when passing gas to no control of bowel movements with daily accidents. Some congenital conditions our program will be successful for are: Imperforate anus/anorectal malformation Hirschsprung Disease Idiopathic constipation Fecal incontinence Cloacal exstrophy Spina bifida What to expect Your family will meet with the team to review the past medical and surgical history and type of bowel control issues your child is experiencing. After a physical exam and radiographic imaging, an individualized program will be created to achieve the goals of bowel control discussed for your child. This can be achieved with dietary changes, medications such as laxatives, and/or enemas. We understand the importance of daily communication, dedication, and teamwork between our medical providers and families to achieve success.

Specialized care for chest wall deformities, including pectus excavatum and pectus carinatum with minimally invasive techniques for faster recovery. Pectus Chest Wall Deformities PECTUS EXCAVATUM PECTUS CARINATUM MIXED CHEST DEFORMITY OUR PECTUS PROGRAM Pectus Excavatum What is it? Pectus excavatum is characterized by a sunken chest caused by the sternum pressing inward. It often becomes more pronounced during growth spurts in childhood or adolescence. Signs and Symptoms Sunken appearance of the chest wall Decreased exercise tolerance Negative self image Evaluation and Diagnosis Diagnosis involves a physical exam, chest CT scans, and tests like echocardiograms and pulmonary function assessments to determine severity. Treatment Nuss Repair (Minimally Invasive): Placement of a metal bar under the sternum to correct the defect, removed 2-3 years later. Ravitch Repair (Open Surgery): Removal of cartilage and placement of a strut under the sternum to reshape the chest. Non operative treatments are sometimes used in unique cases Follow-Up Care Post-surgery follow-ups include monitoring with chest X-rays and restricting contact sports for a brief period of time. The bar is typically removed after 2-3 years. About Pectus Excavatum Pectus excavatum is an indentation to the chest wall that occurs in 1 in 300 people. Patients with pectus excavatum may complain of shortness of breath, especially while exercising, or an inability to keep up physically with their peers. They may feel embarrassed or ashamed of their physical appearance, and this impaired body image can result in lower self-esteem and impaired quality of life. Pectus excavatum often requires an operation to elevate the sternum, potentially improving heart and lung function, as well as improving the appearance of the chest. An extensive evaluation will help determine if a patient is a surgical candidate. At the patient’s initial consultation, we will discuss if and when additional workup testing should be considered. The surgeons perform the Nuss procedure to correct pectus excavatum. The surgery involves two small incisions made on either side of the chest. One or more bars are guided across the chest and then rotated to lift the sternum. Thoracoscopy allows the surgeons to see inside the chest with a camera during the procedure. We utilize a multimodal approach to pain control to ensure patients are able to return to their normal activities as soon as possible. One aspect of this pain control is cryoablation, which uses extreme cold to temporarily freeze targeted nerves in the chest wall. We restrict certain activities for a short period of time, but within a limited time period our patients are able to resume all activities including contact sports. At Austin Pediatric Surgery, an enhanced recovery (ERAS) pathway was created by our team of surgeons, advanced practice providers, anesthesiologists, nurses, physical and occupational therapists, pharmacists, and Child Life Specialists. ERAS is a patient-centered and evidence-based approach to optimize surgical outcomes. This team developed a pectus pathway to improve postoperative pain control, encourage early mobility, and decrease hospital length of stay. This pathway optimizes care before, during, and after your surgery. Pectus Carinatum What is it? Pectus carinatum causes the sternum to protrude outward, leading to a pigeon chest appearance. Signs and Symptoms Asymmetric chest appearance Negative self image Chest pain or breathing difficulties Evaluation and Diagnosis Diagnosed via physical exams, sometimes supplemented with chest X-rays for bony abnormalities. Treatment Brace Therapy: Effective for non-rigid cases, requiring continuous wear for 3-6 months. Ravitch Repair (Surgical): Reserved for severe or brace-resistant cases, involving cartilage removal and sternum reshaping. Follow-Up Care Brace therapy patients are monitored for progress, while post-surgery patients are seen regularly to ensure proper healing. About Pectus Carinatum Pectus carinatum is a less common variant of a pectus anomaly and occurs when the sternum and ribs protrude outward. Many patients with pectus carinatum experience continued growth of the protrusion during growth spurts. Some children may experience shortness of breath, most often during exercise. The most common treatment for pectus carinatum is bracing therapy, though occasionally surgery is indicated. Timing of this treatment is important and is best during early adolescent and teenage years when cartilage is softer and the chest wall is more easily reshaped. We will help you to determine and carry out the right plan for your condition. Mixed Chest Deformity Mixed chest deformities may include a combination of pectus excavatum and pectus carinatum. We also see patients with pectus arcuatum. Pectus arcuatum is a rare chest wall deformity that causes the upper part of the sternum to protrude forward and the lower part to angle backward. Our surgeons will work with patients and families to create individualized treatment plans based on desired outcomes. Our Pectus Program The surgeons of Austin Pediatric Surgery have developed a multidisciplinary Chest Wall Program at Dell Children’s Medical Center. They specialize in treating structural deformities of the chest wall including pectus excavatum and pectus carinatum. The conditions are caused by an abnormal growth of the cartilage that connects the sternum to the ribs. Typically, pectus excavatum and pectus carinatum become more prominent during the rapid growth of early adolescent and teen years, but they can also develop at a much younger age. Sometimes there may be a family history of chest wall abnormalities, however these conditions can also be associated with certain connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome. Our program will work with you and your family to make the best plan for your condition. If you have any questions, please contact our Chest Wall Program Coordinator at: dcchestwallprogram@ascension.org . Pectus Program Testimonials "My Daughter had her surgery with Dr.Josephs in June 2024 and it was a great experience from the start, I had so many questions answered and the staff were so amazing especially Sarah. I am grateful for the care and knowledge that I gained from this experience and for my daughters surgery to go so well! I couldn't thank Dr.Josephs enough for changing the course of my daughters life and making her life better! Forever grateful!" - Mother of patient with pectus excavatum "We had an exceptional experience with Dr. Grethel and his team, and I wanted to share our journey in the hopes it might help others. My 16 year old son Matt had been struggling with his stamina since the indent in his chest started worsening with puberty. He would often feel short of breath quickly, experience premature muscle burn during exercise, and describe the air as feeling “heavy.” After a couple of years of observation and consultation with Dr. Grethel, we felt that the NUSS procedure was the best solution for him. From the very beginning, Dr. Grethel and his team were incredibly professional, helpful, and supportive. They guided us through every step of the process, including navigating the complexities of insurance approval. Their patience and dedication gave us the confidence we needed during the uncertain times leading to surgery. The results have been incredible. Just a few days after the surgery, Matt noticed an immediate difference—he could breathe more easily, even at rest, which he had never realized was a challenge for in a little over six weeks, he was back to running, swimming, rowing, and lifting weights. We are almost 3 months post-op and the improvement in his stamina has been noticeable. We cannot thank Dr. Grethel and his staff enough for their outstanding care and support throughout this journey. We are so grateful for the positive impact this surgery has had on Matt’s life and highly recommend Dr. Grethel and his team." -Valerie L. "No one likes to have to send their child into surgery. No one likes to see the effects of pectus excavatum on their child's physical and emotional health. But the Nuss Procedure performed at Dell Children's hospital changed our child's life forever. The staff guided us through the preparation process, answering all of our questions and scheduling the requisite tests. The procedure involved a minimally invasive surgery whereby a titanium bar was inserted under the ribs, causing almost instant improvement. Because of advances in the procedure, the surgeons do a cryo-ablation of the nerves inside the chest wall, which thaw after 8 weeks. This means the patient is home sooner (two to three days instead of a week or longer in the hospital) and no prescription painkillers are necessary during recovery. It took three months to be completely able to do everything but because of the surgery, he feels more confident, healthier and happier." - Mother of patient with pectus excavatum "Prior to the surgery, I had a sunken sternum, and I had less breathing capacity. I had shortness of breath many times and I felt rather insecure about myself. However, when I went under the surgery, where they placed a metal bar under my sternum and pushed it up, results were almost instant. Following the surgery, I had more breathing room, allowing me to do activities more efficiently and not get as tired. I felt I could do more, and while recovery took time and adjusting, I felt more secure about myself. Now, I am happy with my chest and the results from the surgery, as I can do the activities I love and not get as short of breath!" - Patient with pectus excavatum