Acquired thoracic dystrophy (ATD) is a rare condition in which severe deformity of the chest wall results from extensive open resection of costal cartilages for pectus excavatum in childhood. This can lead to varying degrees of restriction in cardiopulmonary function and can be very difficult to treat. We report a hybrid approach using a minimally invasive and open resection technique followed by reconstruction of the chest wall in an adult patient with ATD.