What Is Pectus Excavatum ?
Pectus excavatum is a congenital deformity of the chest wall in which the breastbone and adjacent ribs are pressed inward, creating a sunken appearance in the center of the chest. Because of this visible hollow, It is often called funnel chest or sunken chest. The depth of the indentation can range from mild and barely noticeable to severe and clearly deforming.
It is usually present at birth, but it often becomes more obvious during childhood and especially in adolescence when the body grows quickly. In many people, pectus excavatum remains a cosmetic concern only. In others, the inward depression can affect the heart and lungs and cause physical symptoms such as shortness of breath, reduced exercise tolerance, or chest discomfort. The condition can also lead to self consciousness and emotional distress, particularly in teenagers and young adults.
How Common Is Pectus Excavatum
Pectus excavatum is the most common congenital chest wall deformity and accounts for the great majority of such cases. It is estimated to occur in roughly one out of every few hundred people, although reported rates vary between different studies. Pectus excavatum is more frequent in males than females, but females can be significantly affected, even if the deformity is partly masked by breast tissue or lower chest muscle volume.
Because pectus excavatum often progresses during growth spurts, many families first notice it clearly around early teenage years. In some people, the indentation remains stable. In others, pectus excavatum deepens and becomes more obvious with age if not evaluated and monitored.
Symptoms and Daily Life Impact
The symptoms of pectus excavatum vary widely and depend largely on how deep the chest depression is and how much it affects the heart and lungs. Many people with mild pectus excavatum have no physical complaints and live active lives. Others experience:
Persistent or activity related chest pain
Shortness of breath, especially during exercise
Fatigue and reduced stamina
Heart palpitations or a feeling of pounding in the chest
Frequent respiratory infections in some cases
Beyond physical symptoms, pectus excavatum can strongly influence body image. Adolescents and young adults may avoid swimming, sports, or fitted clothing because of the visible chest shape. Over time, this can lead to lowered self esteem, social anxiety, and even depressive feelings. For some patients, the psychological impact of pectus excavatum is as significant as any physical limitation.
Causes and Risk Factors
The exact cause of pectus excavatum is not fully understood, but several contributing factors are recognized:
Abnormal growth of the costal cartilage that connects the ribs to the breastbone can pull the sternum inward and create the characteristic hollow
Genetic factors appear important, since pectus excavatum often runs in families and is more common in certain hereditary connective tissue disorders such as Marfan syndrome or Ehlers Danlos syndrome
Connective tissue weakness can reduce the structural support of the chest wall and make it more prone to deformity
Rapid growth in adolescence can reveal or worsen pectus excavatum, especially when the chest wall is still flexible
Pectus excavatum can also coexist with scoliosis, mitral valve prolapse, or abnormal rounding of the upper back, which may further influence posture and cardiopulmonary function.
Is Pectus Excavatum Dangerous
Whether pectus excavatum is dangerous depends on its severity and its effects on the heart and lungs. Many people with mild pectus excavatum have normal cardiopulmonary function and no life threatening problems. However, in more pronounced cases, the inward sternum can compress the heart and reduce lung expansion. This may lead to:
Reduced lung capacity and shortness of breath with exertion
Decreased exercise tolerance and easy fatigue
Displacement or compression of the heart with possible palpitations or rhythm problems
Even if physical effects are modest, the cosmetic and emotional impact of pectus excavatum can seriously affect quality of life. For this reason, pectus excavatum should be evaluated not only in terms of numbers on a scan but also in terms of how it influences daily activities, self image, and psychological well being.
Long Term Complications
Untreated severe pectus excavatum can gradually lead to persistent cardiopulmonary limitations. Over the long term, people may live with chronic shortness of breath, chest pain, and reduced capacity for sports or demanding work. Repeated respiratory infections and poor posture may appear in some patients.
Psychological complications can also accumulate over the years. A person who has been ashamed of their chest since adolescence may continue to avoid social situations, intimacy, or certain careers, even if physical symptoms are modest. In this sense, pectus excavatum can shape life choices if not addressed.
How Pectus Excavatum Affects Heart and Lungs
In more severe pectus excavatum, the sternum can press on the right side of the heart and limit the space available for normal filling and pumping. This may reduce the efficiency of circulation during exertion and contribute to palpitations or fatigue.
The sunken chest can also restrict the full expansion of the lungs. Even a moderate reduction in lung capacity can be felt as shortness of breath or limited endurance, especially when climbing stairs, running, or playing sports. Not every person with pectus excavatum has measurable restriction, but those who do often notice real improvement after successful treatment.
Psychological and Self Image Effects
The visual appearance of pectus excavatum often becomes a major concern in adolescence, when body awareness increases. Some teenagers avoid sports changing rooms, swimming pools, or fitted shirts because of the hollow in the chest.
This self consciousness can lead to social withdrawal, reluctance to form close relationships, and ongoing dissatisfaction with body image. Even when pectus excavatum is medically mild, the psychological burden can be heavy, and this is a valid reason to seek evaluation and discuss treatment options. Addressing both physical and emotional aspects together offers the best path to long term well being.
Diagnosis of Pectus Excavatum
Diagnosis of pectus excavatum begins with a detailed physical examination, where the doctor inspects the chest shape, observes posture, and assesses breathing pattern. To better understand the internal effects, several tests may be used:
Chest radiography to visualize the position of the sternum and ribs
Computed tomography to measure the depth of the indentation and evaluate heart and lung compression
Echocardiography to assess heart function and any displacement
Pulmonary function tests to evaluate lung capacity and breathing efficiency
Based on these findings, the severity of pectus excavatum is graded and the need for treatment is discussed.
Non Surgical Management
Mild pectus excavatum that causes no cardiopulmonary limitation and limited psychological distress may be managed without surgery. Non surgical options include:
Postural correction and targeted exercises to strengthen back and chest muscles and improve overall alignment
Breathing exercises to enhance lung expansion and awareness of deep diaphragmatic breathing
Vacuum bell therapy in selected patients, particularly younger individuals with flexible chest walls, where a suction device is used regularly to gently lift the sternum over time
These approaches do not change the underlying bone structure in severe cases, but they can improve appearance, breathing mechanics, and comfort in mild to moderate pectus excavatum.
Surgical Treatment Options
When pectus excavatum is severe, causes significant symptoms, or leads to substantial psychological distress, surgery is often recommended. The main surgical methods are the Nuss procedure and the Ravitch procedure.
The Nuss procedure is a minimally invasive approach in which one or more curved metal bars are inserted behind the sternum through small side incisions and then flipped to push the chest outward. The bars stay in place for several years and are then removed once the chest wall has remodeled.
The Ravitch procedure is a more traditional open surgery. In this method, the surgeon removes or reshapes abnormal cartilage and repositions the sternum into a more normal alignment, sometimes placing a support bar that is later removed. This approach is often preferred in very complex or rigid deformities.
Both operations aim to restore a more natural chest contour, relieve compression of the heart and lungs, and improve both physical and psychological outcomes in people with significant pectus excavatum.
Surgery in Children and Adults
Pectus excavatum surgery can be performed in both children and adults, but timing and expectations differ. In children and adolescents, the chest wall is more flexible, so correction is often easier and recovery quicker. Early surgery can also prevent long term psychological and physical consequences.
Adults with pectus excavatum can still benefit greatly from surgery, but the chest wall is stiffer, recovery may be longer, and pain management requires careful planning. Nevertheless, many adults report substantial improvement in exercise tolerance, chest comfort, and self confidence after successful correction.
Recovery After Surgery
Recovery after surgery for pectus excavatum usually involves a short hospital stay followed by several months of gradual healing at home. Pain control, breathing exercises, and posture protection are key elements of the early recovery period. Patients are typically advised to avoid heavy lifting, contact sports, and extreme twisting for several months.
Over time, most people can return to full activity, including sports and physically demanding work. Regular follow up visits allow the surgical team to monitor healing and address any issues, such as bar position or residual discomfort. When bars are used, they are usually removed after a few years in a smaller follow up procedure.
Pectus Excavatum Care at Liv Hospital
Liv Hospital offers comprehensive care for people with pectus excavatum, from detailed diagnostic evaluation to personalized treatment planning. Multidisciplinary teams including thoracic surgeons, cardiologists, radiologists, and physiotherapists collaborate to assess the structural, functional, and psychological effects of pectus excavatum in each patient.
Advanced imaging, modern minimally invasive techniques, and structured rehabilitation programs help achieve both functional and cosmetic goals. International patients are supported throughout their journey, from initial contact to long term follow up, with translation services and coordinated logistics.
* Liv Hospital Editorial Board has contributed to the publication of this content .
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .
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Frequently Asked Questions
What causes pectus excavatum?
It is mainly caused by abnormal cartilage growth, often influenced by genetics or connective tissue conditions.
Can pectus excavatum get worse over time?
Yes. It often deepens during childhood and adolescence when the chest wall grows rapidly.
What symptoms should I look for?
Shortness of breath, chest pain, reduced stamina, palpitations, and visible chest indentation are common signs.
Can pectus excavatum be treated without surgery?
Mild cases may improve with exercises, posture training, or vacuum bell therapy, especially in younger patients.
When is surgery recommended?
Surgery is advised when the deformity is severe, causes symptoms, or leads to significant emotional distress.
What is the Nuss procedure?
It is a minimally invasive surgery where curved metal bars are placed behind the sternum to push it outward.
