What is pectus excavatum?

Pectus excavatum is a chest wall deformity that can have various side effects ranging from heart and breathing problems to body image issues. While severe cases are treatable with surgery, there are also some non-surgical methods to help as well.

Updated on
October 6, 2022
A man with pectus excavatum holding a microphone
Table of contents

Pectus excavatum is a chest wall deformity in both children and adults where there is an abnormality in the growth of the cartilage that links the breastbone to the ribs. Pectus excavatum results in an indentation of the chest, which is often referred to as “funnel chest” or “sunken chest”.

It occurs in about 1/500 children (more common in boys than girls), and is often noticed a small dent in the chest after the child is born. As the child grows, the dent often increases in size and depth, until they turn into a young adult and stop growing all together.

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Symptoms of pectus excavatum

Symptoms of pectus excavatum are often a combination of both physical and mental. Depending on the severity, and outlook of each person, it can often lean one way or another.

Physical symptoms of pectus excavatum

For many people with a mild case, there aren’t any physical symptoms whatsoever. For those with more severe cases, people have often complained about things like

  • Slight chest pains
  • Difficulty keeping up to others in exercise
  • Shortness of breath, especially during exercise
  • Fatigue during exercise
  • Visible heartbeat through the chest
  • Irregular heartbeat
  • Dizziness
  • Wheezing or coughing
  • Heart murmur
  • Respiratory infection
  • Pot belly

Psychological symptoms of pectus excavatum

While some people with pectus have no physical symptoms at all, they still deal with immense mental strain while dealing with the body dysmorphia that is associated with pectus. This usually starts at an early age, when children realize their bodies look different from everyone else. Throughout adolescence, people with pectus will often find any excuse to not take their shirt off, which ends up putting a strain on social life, and activities.
Intimate relationships can also be put through strain, as the anxiety of taking ones shirt off, will often be met with excuses in order to not reveal their chest.
There have been cases where the burden of the psychological symptoms over time will lead someone into clinical depression.

What else is pectus excavatum called?

The biggest problem I found when trying to find more information on pectus, is that I never knew what the condition was called. A few obvious terms come to mind, and these are often used by people trying to find out more about their body without knowing the condition. These include

  • Sunken chest
  • Funnel chest
  • Chest hole
  • Indented chest
  • Hole in chest
  • Inverted chest
  • Chest indent
  • Inverted sternum

How is pectus excavatum diagnosed?

The process of diagnosing pectus usually starts with a visit to the family doctor. Once they have verified that you have a case of pectus, they’ll then refer you to a specialist in order to perform some further tests to figure out the severity. These tests include:

  • Pulmonary tests to find out if there are any breathing limitations
  • Chest imaging through MRI or CT scans to determine the severity of the pectus. Once complete, you’ll be provided with the Haller index, which shows the measurements of the sides of the ribcage, as well as the measurement from the spinal cord to the breastbone. The higher the Haller index is, the more severe the case of pectus excavatum.
  • Echocardiograms

How to correct pectus excavatum?

Correcting pectus will always come down to the symptoms, and the severity of the pectus on a case by case basis. There are two primary surgical methods to correct pectus, as well as some experimental methods taking place. The two primary methods are:

Nuss procedure

The Nuss procedure is the preferred option for many, as it’s less invasive than the alternatives. The surgery consists of creating two incisions on either side of the chest, then inserting a curved metal bar through the chest under the sternum. Once inside, the bar is flipped over, forcing the chest dip to correct itself. Depending on the severity, multiple bars can be placed inside the chest to make sure the structure stays intact.
Most patients stay in the hospital for a few days after surgery, then can head home to rest. 3-4 months later, the patient is able to resume light activities, but should keep away from all contact sports for a longer period of time.

After two to three years of the bar in the chest, the patient then undergoes a second surgery to have the bar removed, and the chest will remain in its correct position.

Ravitch procedure

The Ravitch is often referred to as the “open” procedure, as it more invasive than the Nuss. Instead of inserting a bar like the Nuss procedure, the sternum is fractured and pulled forward to the front of the chest wall. A metal plate attached with screws are put into place, keeping the newly moved sternum in place for the future.

Non-surgical options

For those that don’t qualify for surgery, there are some techniques that will help you reduce the appearance of pectus excavatum, but it will never go away fully. In my experience, these options can be broken down into three elements.

Physical exercise

Physical exercise is at the top of this list, because I think it has the most impact on both the mental and physical state of someone with pectus. Not only are you going to feel better, and have more energy, you’re going to look better too. For someone that’s been struggling with their look, these small changes can add up to the biggest difference over time. If you’re new to fitness, I’ve put together a home exercise guide that will guide you through the entire process of looking and feeling better.

Posture and stretching

Another “easy” thing that you can start practicing right away is forming better posture throughout the day. Those with pectus often shrug their shoulders forward in order to hide their chest, but in reality, this only makes the problem worse. By focusing on sitting up straight, and forcing your shoulders backwards while sitting and walking, you’ll start pushing your body into its normal position.
After doing this for a while, I had multiple people say that I looked taller. If you can find a photo of you from the side that you didn’t know was being taken, you’ll often discover *how bad* your posture really is.
If you’re looking for posture exercises to help correct your pectus excavatum, check out my guide here.

Vacuum bell treatment

Last but not least, including vacuum bell treatments with exercise, posture correction and stretching is going to provide the best result beyond surgery. The only issue with vacuum bells, is that they are often out of budget for a lot of people, and some available are of poor quality. I’ve put together a comprehensive guide on the vacuum bell, including recommendations and a measurement tracker.

You can improve the quality of life by making these adjustments to your life. Surgery isn’t the only option.

What are the benefits of pectus excavatum surgery?

When a patient has a severe enough case of pectus to warrant surgery, the most important result is to reduce the pressure on the heart and lungs to avoid any future complications. The added benefit of both surgeries is the immense self-confidence boost one gets from gaining the appearance of a “regular chest”, after years of body-image issues. While there are scars visible for each type of surgery (Ravitch moreso than the Nuss), the vast majority of patients are happy with the results, and there is only a 1% recurrence rate of those with a failed surgery. At this point they can try for another surgery, or live with the chest they’ve been use to.

Who qualifies for pectus excavatum surgery?

If the case is severe enough (usually indicated by the Haller index), you’re most likely going to be eligible for surgery. I’ve read cases where the case wasn’t severe enough to get the surgery, but the psychological effects were enough for doctors to sign off on it. This is all going to depend on who your doctor is, and what their experience with the condition is.

How much does pectus excavatum surgery cost?

This is a hard question to answer, as it’s going to depend on factors that aren’t the same for everyone. Are you in a country with great health care, and a doctor recommendation to get the surgery? If that’s the case, then you won’t be paying anything for either procedure.
If you don’t qualify for medical reasons, paying for it out of pocket is always an option. Prices will range by country, but do not expect it to be cheap. Depending on the procedure and complexity, it can range anywhere from $15,000 USD to $75,000 USD +.

Here's a screenshot of a medical bill from someone in Texas without medical insurance.

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Man sitting cross legged meditating with pectus excavatum

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