Funnel chest is a common thoracic deformity that manifests mainly as a depression of the anterior chest wall. However, this deformity does not always exist alone and, in many cases, can be combined with lesions in other parts of the body. These combined lesions are mostly harmless and generally do not require special treatment. There is one lesion that cannot be ignored, and that is heart disease. Cardiac diseases can be congenital or acquired. Congenital is commonly referred to as congenital heart disease, or precordial disease, while acquired diseases include coronary heart disease and wind heart disease, which are two types of heart disease that occur in adults. Since surgery for funnel chest is mostly done before puberty, combined congenital heart disease is often encountered. This places special demands on the skill of the surgeon. Surgical techniques have evolved to the point where great achievements have been made in both funnel chest and precordial disease, and the treatment of both has become very sophisticated. However, when both are present in one patient, the surgery is not as simple as one might think. The main reason is that very few surgeons can perform both procedures at the same time. Why is this the case? It is largely related to current professional limitations. In the early days of cardiac surgery development, cardiothoracic surgery was not divided, and cardiac surgery and thoracic surgery were performed by doctors in the same department, which facilitated the treatment of many diseases. However, with the refinement of the specialty division, many hospitals have completely separated the two, making it necessary for surgery for the two diseases to be done by different doctors, which undoubtedly limits the treatment of the diseases. So what exactly are the disadvantages of staged surgery? There are two main disadvantages: (1) the patient must endure more surgeries to complete the treatment completely; (2) it increases the financial burden on the patient. If staged surgery is performed, the patient must be treated for one disease first. If the funnel chest surgery is done first, the patient would need to have the plate placed, then removed, and then undergo heart surgery, requiring a total of three surgeries. Of course, if the plate removal is done at the same time as the heart surgery, then a total of two surgeries would be required, which seems like a good option. But in reality, few general thoracic surgeons seem willing to remove the plate for the cardiac surgeon before the heart surgery is performed. This makes such a good option almost impossible. If the heart surgery is done alone first, the plate would need to be placed electively to correct the funnel chest and removed three years later. In total, three surgeries would also be required. As you can see, whichever surgery is done first will cause the patient three times of skin and flesh pain. This is undoubtedly a huge disaster for the patient. And in addition to the physical pain, the patient has to bear the additional cost of the surgery. This is even worse for the patient. That is why splitting the surgery between the two diseases is an extremely cruel option. But unfortunately, since most of the hospitals that patients visit do not have the means to treat both diseases at the same time, patients have to face the harsh reality of having to go under the knife and spend more money. So, how can you complete the surgery for both diseases at once? This requires some special conditions. For one, the hospital must have a special structure, i.e., cardiac surgery and general thoracic surgery in one department. This is necessary to complete similar surgeries. Second, the surgeon must have the skills to perform both funnel chest surgery and cardiac surgery. Both cardiac surgery and funnel chest surgery are highly skilled procedures, and a flawed technique in either area can affect the simultaneous treatment of both. This places very high demands on the surgeon’s skills. Third, the surgeon must master the technique of completing both surgeries in one phase. Completing both surgeries at the same time is not a simple addition of heart surgery and funnel chest surgery, but requires special skills to integrate the two and rational design of technical details. Otherwise the surgery will not be completed. Conditions such as the above are the basic requirements for surgery for such diseases, and without these basic conditions, there is no way to complete the surgery in one stage. Unfortunately, due to the limitations of the medical system in China, it is almost a “rare animal” to have a surgeon who can perform both surgeries at the same time. The Second People’s Hospital of Guangdong Province has a solid foundation in cardiac surgery and general thoracic surgery, which provides the basic conditions for the completion of these surgeries. Over the years, we have conducted a lot of research and practice on surgery for thoracic deformities and congenital heart disease, and have figured out unique techniques for treating both diseases. After clinical practice of surgery on a large number of patients, the technique has been gradually perfected, thus becoming a safe and reliable surgical procedure. Our experience is summarized as follows: First, the skill of sawing the sternum. The depressed sternum is often close to the heart, and it is difficult to saw the sternum from the center, especially when the depression is severe, the operation is more dangerous. To avoid this danger, the gap between the depressed sternum and the heart can be maximized by lifting the rib arch on both sides with a pull hook at the end of the freeing below the glabella. This can effectively reduce the risk of injury to the heart. Second, the technique of traction incision. The presence of the depression makes the traction incision more difficult to operate. Especially for patients with asymmetric funnel chest, it is difficult to retract the incision to a satisfactory degree. For such patients, it is important to keep in mind the fact that it is normal to have unsatisfactory traction, and it is rather abnormal if it is very satisfactory. But no matter how unsatisfactory it is, it must be made absolutely stable. This is a prerequisite to ensure the safety of cardiac surgery. Third, the technique of cardiac surgery operation. In patients with severe funnel chest, their heart is often squeezed into the left side of the chest cavity. Since the incision is done from the median, this makes it very difficult to expose some critical parts of the heart. At this point, sufficient patience is needed to perform the operation. Fourth, the technique of plate placement. After the cardiac surgery, there is already a huge incision in the middle of the chest, so it would be “too much” to use the NUSS incision for the surgery. The test for the surgeon is how to finish the plate placement through the large incision in the center, which is the key to the surgery. Fifth, the skill of shaping the chest wall. After the steel plate is placed, even if it is perfectly fixed, it does not necessarily have a good shaping result. Why would there be such a result? The reason is very simple: the destruction of the force integrity of the thorax by the median incision. To have a good shaping result, it is necessary to operate with some special techniques. Among these techniques, the technique of pre-sculpting is the most crucial one, and only after reasonable pre-sculpting, the post-operative chest wall may become beautiful.