Nuss Bar Removal: When It Comes Out, Recovery and Risks

If you have a Nuss bar in your chest, one of three things is probably on your mind: a removal date coming up, a date nobody has given you yet, or a bar that suddenly feels wrong. Most Nuss bars come out after about two to three years, a little sooner in young children and often later in adults. Removal is a much smaller operation than the one that put the bar in, and in the series below most people go home the same day. The harder questions are pain, getting back to training and how often removal goes wrong. Most have real answers. One has an honest gap.

I was diagnosed with pectus excavatum at 15 and declined surgery, so I’ve never had a bar put in or taken out. I’m not a doctor, and surgery is the right call for many people. Every medical point here comes from a named study or hospital.

Timing first, then removal day, recovery, risks, bar problems, Ravitch hardware, cost and your chest afterward.

When does a Nuss bar come out, and why not leave it in?

The 2024 Pectus Care Guidelines, a multi-society consensus, say Nuss bars should come out after about 3 years, and recommend against leaving one in for life. Children’s Hospital of The King’s Daughters (CHKD), where the Nuss was developed, keeps the bar in for three years. UCSF says two to three years, and Children’s Mercy Kansas City about three.

In practice it depends on age. In 1,821 bar removals in Seoul between 1999 and 2015, bars stayed in for 2.57 years on average, anywhere from 4 months to 14 years:

• under 12: 2.02 years
• 12 to 20: 2.99 years
• over 20: 3.53 years

At Children’s Mercy, among 153 people surveyed years after repair and removal, the median was 2.9 years.

The bar holds the breastbone and cartilage in their new position while the chest remodels. Take it out too early and the dip can come back. Surgeons who redo failed repairs list bars removed too early among the usual causes of recurrence, along with repair at a very young age, a bar that moved, and connective tissue disorders such as Marfan syndrome.

Growth matters too. One small series (Bond 2020) timed removal to bone maturity, judged on wrist X-rays, because children who keep growing afterward seem more likely to see the dip return. None of its 25 teenagers had a recurrence about 3 years later, but that’s one study, not a standard.

What if the bar stays in longer?

Two series found that keeping a bar longer wasn’t harmful in itself, though one showed it made removal harder. In 542 removals in Taipei, mostly in adults, bars left in 6 years or more (median 8) took longer to remove, 85 minutes against 55. They more often had callus, new bone grown around the bar (68.8% against 46.9%), and lost more blood (35 mL against 10 mL). Complication rates (9.4% against 6.3%) and the improvement in chest shape were similar. A two-center Italian series of 231 patients (Infante 2023), with bars kept about 31 or about 69 months, found no significant adverse events in either group.

“For life” is a different matter. In one case report (Gu 2022), a 23-year-old’s bars were left in for 10 years after follow-up lapsed. One bar end had shifted into the chest, the bars had stuck to the pericardium (the lining around the heart), and the chest had developed a new, lopsided shape. The authors described the removal as extremely prone to massive bleeding. One case isn’t a rate, but it shows why the guidelines say not to leave a bar in for good. For the operation that puts the bar in, see my guide to the Nuss procedure.

What happens on pectus bar removal day

Every hospital has its own protocol, and yours sets the rules. CHKD’s removal sheet, written for children and reviewed in October 2023, describes the day like this:

• The day before. Some patients need breathing tests. CHKD says nothing to eat or drink after midnight, but follow your own hospital’s fasting rule.
• The operation. You’re asleep under general anesthesia, with an IV for fluids and medicine. The surgeon usually reopens the side incisions used to put the bar in. A local anesthetic, a numbing medicine, goes into the incision sites to reduce pain afterward. CHKD closes with paper strips, no outside stitches.
• Afterward. A chest X-ray, time in the recovery room, then home if the X-ray is fine and you’re comfortable.

Inside, the surgeon frees the bar, straightens it and slides it out sideways. In a series of 283 adults done this way, average blood loss was 11.7 mL, about 2.4 teaspoons. 3.1% had a complication, mostly a pneumothorax (air trapped between the lung and the chest wall), and none had major bleeding.

UCSF says the operation takes about an hour. In Amsterdam the median was 35 minutes, or 52 if the bar had been infected.

The bigger differences come afterward:

	CHKD (children)	Farach series, 84 removals, 2006 to 2014	Pectus Clinic, London
Chest X-ray after	Always	72.6% had one. 16.4% of those showed a pneumothorax, and none needed a chest drain	Not stated
Going home	Same day for most children	95% the same day	Day case or one night
Activity	Normal activity without restrictions at 10 days	Not stated	Recovery “measured in days rather than weeks”

The Farach team judged a routine X-ray unnecessary. CHKD still does one. Ask what yours does and why.

Pain and getting back to school, work, the gym and sport

I found very little research on pain after removal. CHKD gives a prescription that may be needed for two to five days. In 76 selected children aged 6 to 17 (Wu 2025), an ultrasound-guided nerve block, an injection that numbs the nerves along the side of the chest, lowered pain scores in the first 6 hours and cut opioid use and low oxygen levels after surgery. The authors don’t suggest it for everyone. Ask what your pain plan is.

For everyday life, CHKD’s sheet for children says:

• bathing after 2 days
• school, day care, camp or work within several days
• normal activity without restrictions 10 days after surgery

The Pectus Clinic says that once the bars are out there are no long-term restrictions.

Here’s the gap. I couldn’t find a study or hospital page with a timeline for heavy lifting, contact sport or competition after removal, or any data on adults returning to physical work. CHKD’s 10-day rule is for children and doesn’t name sports. So nobody can honestly hand you a week-by-week gym or sparring schedule, and I won’t invent one.

Before you leave the hospital, ask your surgeon about lifting, running, contact, sparring and competition separately. Even with the bar in, contact rules vary a lot between hospitals. I’ve compared what four centers say about boxing and wrestling after the Nuss.

Risks of bar removal, with real numbers

A 2021 review calls removal generally safe, with rare major complications such as life-threatening bleeding, more likely after complex repairs. The large series count problems differently:

Series	Patients	What was counted	Result
Aarhus, Denmark, 2003 to 2019	1,574 removals	All complications, graded from minor to life-threatening	4.1% overall. Bleeding 1.3%, infection 1.5%, severe bleeding 0.3% (5 people)
CHKD	1,628 removals	Blood loss	Over 150 mL in 0.43%, over 2 liters in 0.12%. No heart injuries, no deaths
Mayo Clinic Arizona, 2013 to 2022	683 adults (median age 34), 1,555 bars	Complications	Bleeding 2.05%, pneumothorax 0.88%, infection 0.59%, fluid around the lung 0.44%
Seoul, 1999 to 2015	1,821 removals	The most common problem	Wound seroma, including infection, 2.36%. A seroma is a pocket of fluid under the wound
Bonn and Mainz, Germany	279 removals (median age 19)	All complications	17 complications in 15 people (5.4%), mostly minor. One needed a drain for fluid around the lung

None of these is your personal risk, but across these series problems hit a few people in every hundred, and most were minor. Who’s at higher risk? The studies don’t fully agree:

• Aarhus: older age, and removing more than one bar.
• Mayo Clinic Arizona, for bleeding: a bar that had eroded into the breastbone, a bar that had moved, more bars, and a previous revision operation.
• Zuyderland (Franssen 2026): in 434 patients, 4% had a complication at removal or after, against 16% from insertion until then. Being 24 or older at insertion was the only predictor.
• Bonn and Mainz: age, sex and number of bars didn’t predict complications.

If any of those apply to you, ask your surgeon how they change your risk.

Serious bleeding, and where to have it done

Serious bleeding is rare, but it can be life-threatening. In Mayo’s adults, most bleeding came from the bar’s track and was stopped by packing, but one patient with badly moved bars needed the breastbone opened and a heart-lung bypass machine to repair the aorta. CHKD’s authors say removal belongs where the team can open the chest straight away, and the 2021 review recommends hospitals with adequate resources, including cardiac surgeons. Ask your center whether it has both. If you’re still choosing, see my list of pectus surgeons and centers and how to vet them.

After removal, CHKD tells families to call the doctor for:

• fever
• a cough that won’t go away
• chest pain, especially with deep breaths
• redness, drainage or swelling at the incisions
• any trouble breathing

Problems before removal: a bar that pokes out, an allergy or an infection

When the bar pokes out or moves

A bar end you can newly feel or see under the skin, or a change in chest shape, can mean the bar has shifted. Surgeons call this displacement. I found no study that measures “poking out” on its own, and displacement rates vary widely:

• A 2025 review of 13 studies covering 23 years found rates from 0.9% to 33.3%, depending on age, chest wall stiffness, bar length and technique. Stabilizers and other ways of fixing the bar lowered rates.
• The 2024 guidelines put it at about 1%.
• In 695 Nuss patients in Amsterdam, treated from 1999 to 2024, 5.6% needed another operation for a dislocated bar, and these cases were associated with infection.

Not every sensation is trouble. Children’s Mercy’s post-operative sheet calls popping or clicking as the bar and stabilizers move normal. Texas Children’s tells families to go to the emergency department for a sudden change in how the chest looks, severe unexplained chest pain, fever or shortness of breath. Anything in between, like a bar end you can suddenly feel, is a reason to call your surgeon, not to wait for removal day. More in bar movement after the Nuss procedure.

Metal allergy: steel vs titanium

Most bars in the large US series here are stainless steel, which contains nickel and chromium. Titanium is used for people with a known metal allergy, and the Pectus Clinic in London says its bars are now titanium, so allergy is very rarely a concern there. Titanium allergy does exist, but it’s very rare: one case report (Sakamoto 2014) describes a 17-year-old treated with oral steroids.

How common is allergy to steel bars?

• 19 of 862 Nuss patients (2.2%) at CHKD between 1987 and 2005. It showed up as a rash, a granuloma (a firm lump of inflamed tissue) or fluid around the lung, and is often misdiagnosed as infection, the authors say. Three bars came out because the skin over them broke down, and the symptoms cleared.
• 15 of 842 steel-bar repairs (1.8%), in 932 patients over 10 years. Allergy was more common in females and with a personal or family history of metal sensitivity. Five allergic patients had a negative patch test, where small amounts of metal are taped to the skin, before surgery.
• 41 of 639 (6.4%) at another center (Shah 2014), counting anyone with clinical signs or a positive patch test, including positive tests with no reaction.

So a negative patch test doesn’t rule allergy out, and a red patch over the bar isn’t automatically infection. Tell your surgeon about any metal sensitivity in your family, and show them a rash early.

Infection around the bar

Of 1,717 Nuss patients at CHKD, 3.5% of those treated from 2005 to 2013 developed an infection, up from 1.5% earlier. 60% were superficial and didn’t need surgery, and bars stayed in for 90% of all infections and 75% of deep ones. In Amsterdam, 4.0% had a bar infection, a median of 2 months after surgery, with redness, pain or discharge, and deep infections more often needed an operation. So an infection needs your surgeon quickly, but at CHKD it rarely meant losing the bar.

Removing Ravitch plates and bars

The Ravitch procedure is the open repair: the surgeon removes overgrown cartilage and holds the breastbone forward with a plate and screws, struts or a small bar. That hardware comes out much sooner. Cleveland Clinic says 6 to 12 months. Children’s Hospital of Philadelphia removes its bar at about 6 months, and UCSF takes struts out about a year after surgery, in an outpatient procedure of about an hour.

What bar removal costs

I couldn’t find a verified price for Nuss bar removal anywhere. It’s a second operation with its own anesthesia and its own bill. My reading: since it comes two to three years after the first, it will usually fall in a new insurance plan year, with a fresh deductible. Ask for a written quote. More in the second bill: bar removal.

What changes after the bar comes out

Will the dip come back? For most people, no. But the studies measure it in different ways:

• Needing another operation. In the Seoul series of 1,821 removals, 9 people (0.49%) had a recurrence and 7 (0.38%) had a redo repair. Of 1,215 Nuss patients at CHKD, 95.8% had a good or excellent result at removal, and 1.4% needed another operation for recurrence.
• Recurrence on X-ray. In 99 removals in Seoul, mostly in young children (mean age 8.9 at repair), the chest sank a little in the first 6 months after removal, then held by 1 year. 9 of the 99 met the study’s X-ray definition of recurrence. The only independent predictor was how well the chest had been lifted at the original operation.
• What patients notice. At Children’s Mercy, a median of 9.6 years after repair, 96.7% were satisfied and 2.0% had needed another procedure, but 30.7% noticed their chest moving back in somewhat. Only 26% answered the survey, so treat that as rough.

There’s no single recurrence rate to quote, because these numbers count different things. For what lowers the risk, see preventing recurrence after surgery.

Heart and lung function improve modestly. In 45 patients tested before repair and after removal (Lawson 2005), lung function improved by a small but significant amount, more in those who were over 11 at surgery. In 43 patients given a heart ultrasound under exercise stress at both points, 83% reported better exercise capacity and the right side of the heart filled better. Both are small studies.

CHKD asks patients back one year after removal to check chest growth and lung function, and the guidelines note some surgeons follow up for 5 years to catch recurrence. Keep those appointments.

Where to go from here:

• Your bar is still in. My post-surgery pectus excavatum program has a chapter on living with the bar and getting it out. Your surgeon’s instructions come first.
• Your bar is out, or you’re still deciding on surgery. Take my free 1-minute quiz for a sense of where your chest stands and which route fits.

Nuss bar removal FAQ

Will I be asleep for bar removal?

Yes, under general anesthesia at both CHKD and the Pectus Clinic. Some teams add a nerve block for pain afterward.

Will I get new scars?

Usually not. CHKD and the Pectus Clinic both remove the bar through the original side incisions. For looking after them, see my guide to surgical scars.

Can the bar come out early?

Yes, when there’s a reason. In the Seoul series, 3.2% came out earlier than planned. At CHKD, three bars came out early for infection, with no recurrence 2 to 4 years later, and three for allergic skin breakdown. Removing one early just to be done with it is different, since early removal is a listed cause of recurrence.

What is the CPT code for pectus bar removal?

Zimmer Biomet’s coding guide for its pectus support bar, issued in January 2026, lists CPT 20680, “Removal of implant; deep”. That’s a manufacturer’s guide, not insurer policy, so check with your hospital’s billing team.

Do I keep doing my exercises after removal?

CHKD says yes: posture exercises and deep breathing with breath-holding, twice a day, still apply after removal. If you need a routine, my breathing exercises are a place to start.

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