[4]: 1277 Through two small incisions in the side of the chest, an introducer is pushed along posterior to the sternum and ribs, and anterior to the heart and lungs.

This option is often not preferred by surgeons as it can cause extreme amounts of additional pain during recovery and up until the strings are removed.

[citation needed] The retrosternal passage performed in the Nuss procedure carries a high risk of damaging the heart.

This is why multiple sternal elevation systems have been developed to increase the space between the heart and the sternum in order to pass the thoracoplasty rod more safely.

However, older children and adults typically require a greater recovery time due to the increased ossification (and thus decreased flexibility) of their bones.

[citation needed] In this case, the difficulty and length of recovery should be carefully considered prior to making the decision to undergo the operation, as the limitations to lifestyle, functionality and comfort can be dramatic for many months.

Fully grown adults may require from four weeks to many months before they can resume normal activities, including work.

For six to twenty-four hours after the operation, the patient generally will have a Foley catheter to minimize risk of movement that could displace bar, and because the epidural can interfere with normal urination.

[citation needed] Studies using sonography have shown post-operative changes in many patients such as an acute angulation of the costochondral junction and rib fractures near the pectus bar.

The recovery from these psychological symptoms can also take some time, though many patients report improvements in confidence and self-esteem after only a few weeks, once the effects of the surgery can be noticed.

Ultimately, almost all patients report a noticeable improvement in their confidence and body image after they have completely recovered from the operation.

This is the reason for the restriction on driving, because a sudden defensive maneuver, such as a jerk of the steering wheel, could dislodge the bar up to six weeks directly after the surgery.

Other complications which may occur include hemothorax, pleural effusion, pericarditis, wound infection and pneumonia and acquired scoliosis.

Older children may also struggle with adjusting to living in their changed bodies during the several months of healing due to the pain and limitations.