The surgical treatment of funnel chest has been going on for more than 100 years. During this time, several methods have been used in clinical practice. There is a special reason for the creation and promotion of any method, that is to say, it has its own unique indications and it has certain effects, otherwise its existence would be meaningless. With the development of surgical techniques, many traditional methods are gradually replaced by more desirable surgical methods and eventually withdrawn from the clinical frontline, which is the inevitable development of history. However, it is very sad that the “obsolescence” of some techniques is not only the result of the technology itself, but also the result of physician and patient preference. From the doctor’s side, we can not exclude the factor of blindly following the wind; and from the patient’s side, the ignorant worship of certain trends has played a significant role. The combined enthusiasm of both doctors and patients is bound to produce so-called “standard procedures” like NUSS surgery. This type of surgery has a good reputation and has its own convincing merits, but is it really flawless? In the words of Zhao, “Whoever uses it will know”. Doctors who have used NUSS surgery know it, and so do patients who have been under the doctor’s knife. The surgery is not the myth it is made out to be. When faced with unsatisfactory NUSS results, some doctors blame themselves for their own incompetence, and patients blame their doctors for their incompetence. This is actually quite wrong for doctors. The key problem may not be the doctor himself, but rather the flaws of the great NUSS surgery itself. It is important to understand that the world is very real and there is no real cure-all surgery or god. For a long time, people cried out for NUSS surgery at the mention of funnel chest surgery, so much so that doctors started NUSS without even understanding the features of the deformity in its entirety. This is a very rare and absurd behavior in surgical clinical practice. It is considered absolute luck if such a surgery is more satisfactory, while most of the results are not satisfactory. This is the ill-effect of blindly following the trend. The choice of surgical procedure is actually determined by a variety of factors. First, the surgeon must be clear about the purpose of the patient’s surgery. Funnel chest surgery is different from general surgery because it is also cosmetic and even aesthetic in nature. When a patient undergoes surgery, it is often not simply to cure the disease, which requires that the surgeon not use a single procedure to complete the treatment; second, the choice of surgical approach must take into account specific intraoperative issues. These issues include: (1) the choice of skin incision; (2) trauma; and (3) the outcome of the surgery. These three issues directly determine whether the choice of surgical approach is reasonable. The fundamental lesion of funnel chest is the deformity of the thorax, so whether it is a treatment or cosmetic, the first task is to eliminate the deformity of the thorax. Theoretically, as long as there are enough materials, any deformity can be “repaired” beautifully, which is the same reason as the overhaul of a car. In the case of funnel chest surgery, all the excess structures can be removed and the remaining structures can be completely shaped and fixed. After such treatment, the shape of the chest can definitely be restored. Of course, unless the “repair” master is really bad or too rough, then it is not the problem of surgical choice, but the master is originally a stupid guy. But, “overhaul” is a big price. The first cost is the problem of damage, which is the inevitable result of a major effort on the thorax. The second price is the size and scale of the incision, which is also the cost of having to consider. In order to do a big job on the thorax, small fights can not get good results, so there must be a big action, big action means big damage, otherwise it is impossible to complete the real “overhaul”. And to make the surgery beautiful, and must have a good vision. If the deformed structure is not revealed, no operation can be performed, so “overhaul” often means a large opening. Unfortunately, if the bones of the patient’s chest are basically restored to their normal shape after surgery, but the skin surface is covered with large incisions, many patients will certainly curse the surgeon. This is a reality that many patients do not want to accept. As the standard of living improves, so does the patient’s demand for surgery. This is a good phenomenon, but the reality is that many surgical options tend to be deformed. The most common craving is to ask the surgeon not only to make his bones look good, but also not to have major damage and, more importantly, not to have large incisions and scars. This is obviously in accordance with the standard of the miracle doctor to ask the thoracic surgeon. Faced with such a thirst of patients, many doctors simply retreated from the circle and they never did funnel chest surgery again. They know that they are not Hua Tuo, not Bian Magpie, but an ordinary person, and they have no way to satisfy the endless appetite of patients. As for those who remained, except for those who blindly met the excessive needs of patients, they were all doctors who brought their own suffering. This has led to various oddities in the field of funnel chest treatment today. For many years, we have used almost all surgical methods in the clinic to treat funnel chest. Many doctors feel helpless in the face of today’s perverse development of the concept of funnel chest treatment, and we also feel the difficulty of our work. However, as a surgeon, you should have a clear head at all times. If you are always led by the clouds or even by the nose of the patient in the process of choosing the surgery, not only will the patient not be happy, but you will also suffer in the end. Here are some of our feelings. 1. You cannot be bound by the concept of “minimally invasive”. Nowadays, all surgeries are minimally invasive, and it seems that if you leave minimally invasive surgery, you are in a mess. This is actually a very bad understanding. Minimizing trauma is the soul of “minimally invasive surgery” while ensuring surgical safety. However, if we pursue minimally invasive surgery without considering the quality of surgery, minimally invasive surgery is actually harmful, not only to the doctor but also to the patient. For serious thoracic deformity, the deformity of the bony structure of the thorax itself is very serious, and it is a big project to complete the deformity shaping. For such a large project, if you then emphasize the “minimally invasive”, then it is completely bullshit. It is the same as repairing a car. If you have a car in front of you, but the owner won’t even let you move the broken parts, how can you have a master who doesn’t know how to fix your car? When faced with a severe funnel chest, doctors do encounter the “owner” of the car that is killing them. In this case, if the doctor still goes along with the patient using the so-called minimally invasive surgery, there will be less post-operative sadness and tears. 2, can not be too concerned about the aesthetic problems of the incision. The principle of incision selection is to minimize the incision as much as possible under the premise of completing the surgery, and to choose the incision in a hidden area as much as possible. After all, such an operation is not a small operation, when faced with a large number of necessary surgical operations, if the patient still insists on a small incision, it will be difficult for the doctor to die alive. 3, the choice of surgical methods must be specific deformity specific analysis, must not be a one-size-fits-all. Funnel chest itself is a variety of deformities, in addition to the typical deformity, there are still some special deformities. While NUSS surgery is not a problem for patients with typical deformities, it is no longer ideal for patients with extensive deformities, deformities that are combined with flat chest, deformities that are combined with pectus excavatum, and other more complex deformities. In such cases, why not consider traditional surgical methods? 4. Be sure to eliminate any prejudice against traditional surgical methods. The main reason why people have been “scared” of traditional surgery in recent years is because of the blind admiration for NUSS surgery. If traditional surgery is really useless, how can it have existed for decades? Doctors do surgery to cure diseases rather than play with fashion, and what is fashionable should be learned, but what is old should not be denied. 5. Good use of available shaping materials. Funnel chest surgery has been developed so far, and many surgical styles and materials have been used clinically. And with the disappearance of traditional surgery, many materials are no longer used. The only material available in the clinic today seems to be the steel plate for NUSS surgery. This has certainly limited the surgery. In fact, the materials that can be used in current surgical clinics are not only NUSS plates, for example, there are a number of commonly used orthopedic materials that can be used. With the materials in place, the implementation of the surgery will be simple. 6, do not be a slave to the thoracoscope. The application of thoracoscopy is entirely the result of the development of “minimally invasive” surgery. Thoracoscopy brings great convenience to clinical work, but if even the chest wall surgery can not be separated from this object, the doctor will really become a slave to the mirror. This is the greatest sadness of thoracic surgeons. In conclusion, surgery of funnel chest is a complex system project, and because the deformity is very different, the surgical method must be “the right medicine”. The best surgical results can be achieved by breaking the superstition of “NUSS” surgery.