A 12-year-old girl with a keel chest, underwent cosmetic repair of the severe deformity. The deformity was corrected by subperichondrial resection of the all deformed costal cartilages, transverse osteotomy through the anterior cortex of the sternum, detachment of the xiphoid process, bending of the posterior cortex of the sternum, and resection of the lower end of the sternum. The sternum was maintained in its corrected position by traction force of the rectus muscles through the reattached xiphoid and the shortened perichondrial tissues and by reapproximating the pectoral flaps in the midline over the sternum. Postoperative echocardiography revealed that the left atrium was pressed against the vertebrae by the corrected position of the sternum.