Chondromanubrial (arcuate) pectus carinatum is the rarest protrusion deformity of the chest. Its surgical correction was first described by Ravitch in 1952. We have recently encountered five patients with this deformity who have provided additional insight into the anatomy and optimal repair of this condition. It is notable for a short nonsegmented sternum with marked posterior angulation at the site of the normal chondromanubrial junction. It is optimally corrected by subperichondrial resection of the second to the seventh costal cartilages with a broad wedge-shaped osteotomy through the anterior cortex of the sternum at the point of maximal angulation. Anterior displacement of the sternum is achieved by closing the osteotomy with heavy silk sutures while the costal cartilages are regenerating.