What is pectus excavatum?

Pectus excavatum is a relatively common congenital deformity (a defect that is present at birth) in which the chest appears sunken. The condition is sometimes called concave chest or funnel chest. The deformity can become more visible as your child grows up, especially during puberty. It is more common in boys than girls.

What are the symptoms of pectus excavatum?

Besides changing the appearance of the chest, children with mild pectus excavatum often have no other symptoms. However, they may feel self-conscious about their chest and want treatment for that reason.

Children with moderate or severe forms may have other symptoms, such as:

  • Chest pain and/or shortness of breath, especially while exercising. This occurs because the sunken shape of your child’s breastbone can put pressure on the lungs.
  • In the most severe cases, the breastbone can also put pressure on the heart so that it cannot pump blood correctly

Children with moderate or severe pectus excavatum may also suffer from being self-conscious about the appearance of their chest.

What causes pectus excavatum?

Doctors don’t know yet why some children are born with pectus excavatum. Some cases may be inherited (passed down in families). 

In some children, pectus excavatum is a symptom of other conditions, like scoliosis, Marfan syndrome, Noonan syndrome, or Ehlers-Danlos syndrome.

How do doctors diagnose pectus excavatum?

Pectus excavatum can be diagnosed with the following exams:

  • A physical evaluation, where a doctor will determine how severe the deformity is and if it affects your child’s lungs or heart.
  • If necessary, the doctor may use imaging tests like an X-ray or CT scan to look inside your child’s chest.

The doctor will also check if your child’s case of pectus excavatum is a symptom of another condition.

How do doctors treat pectus excavatum?

Treatment for pectus excavatum depends on your child’s symptoms. Many mild cases do not require treatment. If your child does want treatment for a mild form of the condition, options include:

  • Chest exercises to strengthen and reshape the chest. Working the pectoral muscles will make them bigger and help cover the sunken area of the chest but will not get rid of the deformity
  • If your child is self-conscious about the appearance of their chest, ask their doctor about speaking with a mental health provider

Pectus excavatum surgery

In moderate to severe cases of pectus excavatum, the doctor may recommend that the chest be surgically fixed. This can be done in two ways:

  • The Nuss procedure is a minimally invasive surgery where steel bars are placed horizontally inside the child’s chest behind their breastbone. Over time, the bars push the breastbone outward to improve the appearance of the chest. The bars usually stay in place for 2-4 years.
  • The Ravitch procedure is more invasive than the Nuss procedure but creates better results in some cases of pectus excavatum. In this surgery, the doctor will remove the extra cartilage from around your child’s breastbone to make it flat. The doctor might also insert a steel bar behind the bone to help it hold its shape.

Your child will not be able to participate in intense physical activity (ex. sports) for 2-3 months after the surgery takes place. However, the doctor may recommend light exercise like walking combined with physical therapy sessions to help the chest heal after the operation.