Microtia is one of the most frequent congenital craniofacial deformity. Costal cartilage grafting has been widely accepted at the first choice for treating patients with microtia. However, harvesting of rib as a source of cartilage can result in significant chest deformity. The relevant factors such as the age of patients, methods of cartilage harvest and costal cartilage regeneration mechanism that influence the development of the chest wall after ear reconstruction were reviewed.