A bar placed to correct a sunken chest is designed to come out again, usually around three years after the repair. Removal is a far smaller operation than the original correction, and the published complication rate is low. The difficulty for many people is not the operation but the route to it: the surgeon who placed the bar may be abroad, may have moved, or may no longer be operating, and a substantial share of UK pectus repairs are now done privately or overseas. You do not have to return to the original surgeon to have a bar removed. Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), removes pectus bars placed elsewhere and sees patients from the age of 16 upwards at London Bridge Hospital and The Lister Hospital Chelsea within 2–3 days. Self-referrals welcome.
Last reviewed: September 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
The standard interval from repair to removal. In one single-institution series the median was 1,139 days, with a median age at removal of 19.1 years.
Surgery abroad, a surgeon who has moved or retired, or a service that no longer exists. The bar still comes out, and a thoracic surgeon can remove one placed by someone else.
Complications were reported in 4.8% of 542 removals, with none graded severe. Reported rates across the wider literature range from 2% to 15%.
The bar is not an implant in the way a joint replacement is. It is a temporary strut that holds the sternum in a corrected position while the chest wall remodels around it, and it is designed to be taken out again. The convention is around three years, and the published experience matches it: in a single-institution series of elective removals the median interval from insertion to removal was 1,139 days — a little over three years — with a median age at removal of 19.1 years [1].
Three years is a compromise rather than a magic number. Too short and the correction has not had time to hold; too long and the operation becomes more difficult for no gain. Most people are told the date at the time of their repair, and for those who had the operation in a settled service with a follow-up clinic, removal is simply booked. The people who reach this page are usually those for whom that did not happen.
If you are past three years, you have not missed a deadline. Bars are removed successfully well beyond that point, and the section below sets out exactly what the delay costs and what it does not.
The most useful study here examined 542 patients having bars removed and compared those in place under six years with those in place six years or more [2]. It answers the question people actually ask, which is whether leaving it has done any harm.
Read together, those findings say something reassuring and something practical. The reassuring part is that a bar left far longer than intended does not ruin the result — the chest looked the same afterwards and the complication rate was not higher. Anyone who has spent years worrying that they have left it too late can put that down.
The practical part is that it is a bigger operation than it needed to be. Bone forms around a bar that has been in place for years, so it has to be freed before it can be withdrawn, which takes longer and bleeds more. Overall, complications after bar removal were reported in 4.8% of that series with none graded severe, and rates across the wider literature fall between 2% and 15% [2,3]. There is no advantage in waiting, and a modest cost to it.
The standard advice, and the advice given here too, is to return to the surgeon who performed the repair. They know precisely what was put in, how many bars there are, how they were secured, and where the stabilisers sit. That is genuine knowledge and it makes the operation simpler. But it presupposes that the route is still open, and for a good number of people it is not.
The commonest reason. Travelling back for a day-case-scale operation is expensive and impractical, and some people have since moved country entirely. The bar still has to come out, and it can come out here.
Services move and people change jobs. A patient whose repair was done at a hospital that no longer offers the operation can find there is nobody at that address who does it.
People move away for university or work, appointments are missed, and years pass. This is common and it is nobody’s fault. It is also the group most likely to arrive well past three years.
What is needed to plan the operation safely is information about what is in there. The operation note is ideal — number of bars, stabilisers, wires, which side. Where none of that survives, a chest X-ray shows the number and position of the bars and is usually sufficient. Bring whatever you have, including photographs of discharge paperwork, and do not delay booking an assessment because the documentation is incomplete.
The bar is approached through the original incisions at the sides of the chest, so there is generally no new scar. Any stabilisers or fixation wires are released first, along with any bone that has formed around the bar. The bar is then straightened and withdrawn. It is done under general anaesthetic, and while some centres perform it as a day case, a short inpatient stay is common and is the safer default where the bar has been in a long time.
The comparison people want is with the original repair, and it is not close. The Nuss procedure moves the sternum into a new position against the resistance of the whole chest wall, and the first weeks afterwards are genuinely painful. Removal releases that structure rather than creating it. Operating times in the published series run from under an hour for a straightforward removal to something over an hour where bone has formed around a long-standing bar [2].
Recognised complications are uncommon but real, and they are the reason this is done in a proper theatre with proper anaesthetic cover rather than treated as a trivial procedure. They include pneumothorax, bleeding, wound problems and, very rarely, injury to structures behind the sternum. That last risk is the reason that documentation of what was implanted, and a recent X-ray, matter before the day.
Pain that is new, or on one side only. Some discomfort is expected for months after a repair and then settles. Pain that arrives later, or that is clearly worse at one end of the bar, is worth assessing rather than enduring until the removal date.
A bar that feels as though it has moved. Displacement is a recognised problem and is one of the reasons for earlier removal or revision. A chest X-ray answers it directly, which is why an examination and a film are the first steps rather than a scan.
A prominence or a point you can feel at the end of the bar. Commonly the stabiliser rather than the bar itself. Usually nothing, but it deserves a look, particularly if the skin over it is thinned or sore.
Overdue removal with no symptoms at all. The commonest reason people arrive here, and there is no need to develop a problem before being seen. If the bar is past its intended date, that alone is a reason to book an assessment.
Occasionally someone needs an operation through the breastbone — a cardiac procedure, a thymus gland operation, a mediastinal tumour — or a lung operation, and still has a pectus bar lying across the front of the chest. It is not a common scenario, but when it arises it is important, because the bar sits directly in the way of the approach and it changes the plan.
In most cases the bar is removed either in advance of the main operation or at the same sitting, and which of those is right depends on the urgency of the main procedure and on how long the bar has been in. What matters most is that the question is raised early. It is exactly the kind of detail that surfaces late, when the main operation is already being planned by a team focused on something else entirely.
If you have a bar in and any chest or heart operation is being discussed, say so at the first opportunity. It is also worth mentioning a bar to anyone arranging an MRI scan, because the implant needs to be identified and checked for compatibility beforehand.
Some people arrive with a bar that is due out and a chest that has not been adequately corrected. Those are two different problems, and only one of them is solved by taking the bar out. Where the correction has not held, or where the original repair has left a result that needs revising, the operation required is a redo pectus repair — a technically demanding procedure that belongs in a pectus centre with a team that does it regularly.
That distinction is stated here rather than discovered afterwards. It is better to be told at the consultation that the right destination is somewhere else than to have a bar removed and then find the underlying problem is unchanged. Where that is the position, the referral is made and the reasoning explained.
The same applies to a first repair. This page is about removing a bar that is already in, not about correcting a sunken chest that has never been operated on. Anyone in that position needs a pectus service, and the section below explains where those currently sit in England.
Pectus surgery has an unusual commissioning history in England. It was decommissioned as a routinely funded procedure, and although it has since been recommissioned in a restricted form, NHS England does not fund it routinely — the current policy admits only a small number of patients a year with severe physiological consequences. The predictable result is that a large share of repairs in this country have been carried out privately or overseas, which is precisely why so many people end up with a bar and no clear route to having it removed.
At the time of writing, pectus repair in England is concentrated at a small number of centres, with a national multidisciplinary team reviewing cases. A randomised trial, RESTORE, is running to establish whether surgery improves physical function compared with no surgery, and its result is expected to inform the next commissioning decision. Until then the position remains restrictive.
Removal sits outside all of that. It is not corrective surgery and no commissioning policy restricts it: a bar that has been placed needs to come out, wherever it was placed and however the original operation was funded. That is the single most useful thing to understand if you have been told that pectus surgery is not routinely available.
Dr Okiror sees and treats patients from the age of 16 upwards, which covers most people reaching the point of bar removal. Younger or more complex patients are managed jointly with the paediatric team at Evelina London, and the arrangements are agreed individually. The relationship between age and this operation is set out further on the chest and lung surgery for teenagers and young adults page.
Bring the operation note from the original repair if you have it, or failing that the date, the hospital and the country. Any chest X-ray taken since the repair is useful. If you have none of this, come anyway — a film can be arranged and it answers most of the questions that matter for planning.
Private appointments at London Bridge Hospital and The Lister Hospital Chelsea are typically available within 2–3 working days, with outpatient consultations also available at the HCA clinics in Canary Wharf and the City of London. Self-referrals welcome. Bar removal is a coded, recognised procedure and is generally covered by insurance, though authorisation should be obtained in writing before booking, particularly where the original repair was self-funded or performed abroad. Second opinions are available for patients already under another team’s care.
Questions most commonly asked by people whose pectus bar is due out, or who cannot get back to the surgeon who placed it.
Book an Assessment →Or call Jo Mitchelson:
020 7952 2882
Self-referrals welcome. Private appointments at London Bridge Hospital and The Lister Hospital Chelsea within 2–3 days, for patients from the age of 16 upwards. Bring whatever documentation you have from the original repair, and if you have none, come anyway.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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