What Is Pectus Excavatum? Causes And Treatment

Pectus excavatum is a condition where the breastbone (sternum) grows inward, creating a noticeable depression in the center of the chest. It is the most common congenital chest wall deformity, and while the exact cause is not fully understood, it often runs in families. Treatment ranges from monitoring and physical therapy to surgical correction, depending on the severity of the condition and the symptoms it causes.

What Is Pectus Excavatum?

Pectus excavatum is sometimes called “funnel chest” because the chest appears scooped out or hollowed. The sternum and the ribs attached to it curve inward instead of lying flat. This can happen on one side more than the other, making the chest look asymmetrical.

The condition is present at birth, but it often becomes more noticeable during the rapid growth spurts of adolescence. Many people with mild pectus excavatum have no health problems at all. Others may experience physical symptoms because the inward curve reduces the space available for the heart and lungs.

What Causes Pectus Excavatum?

The precise cause is not known. Researchers believe it involves abnormal growth of the cartilage that connects the ribs to the sternum. This cartilage grows too quickly or in the wrong direction, pushing the sternum inward.

There is a clear genetic link. About 35 to 40 percent of people with pectus excavatum have a family member with the condition. It is also associated with certain connective tissue disorders, including Marfan syndrome and Ehlers-Danlos syndrome. However, most people with pectus excavatum do not have one of these syndromes.

Boys are affected more often than girls. Estimates suggest the condition occurs in about 1 in every 400 to 1,000 births. The wide range reflects how mild cases are often never formally diagnosed.

What Are the Symptoms?

Symptoms depend heavily on how deep the depression is. Many people, especially those with mild cases, have no symptoms at all. The condition is often discovered during a routine physical exam.

When symptoms do occur, they typically appear during adolescence. Common complaints include:

• Shortness of breath during exercise or physical activity
• Reduced stamina compared to peers
• Rapid heartbeat or palpitations
• Chest pain, especially after exertion
• Fatigue

Some research suggests the inward sternum can compress the heart slightly, affecting how efficiently it pumps. This compression may explain why some teenagers report feeling “out of shape” despite being active. The heart and lungs usually function normally at rest, but the reduced space becomes more limiting during exercise.

How Is Pectus Excavatum Diagnosed?

A doctor can often diagnose pectus excavatum with a simple physical examination. They will look at the chest shape and may ask the person to take a deep breath or raise their arms to see how the depression changes.

To assess severity and impact, doctors use imaging and other tests:

• Chest X-ray or CT scan — These provide a clear picture of the chest structure. A CT scan can measure the Haller index, a ratio that compares the width of the chest to the distance between the sternum and the spine. A Haller index above 3.25 is generally considered severe.
• Electrocardiogram (ECG) — This checks for heart rhythm problems, which can occur if the heart is compressed.
• Echocardiogram — This ultrasound test looks at heart structure and function.
• Pulmonary function tests — These measure how well the lungs take in and release air.

These tests help doctors determine whether the deformity is causing measurable health problems or is mainly a cosmetic concern. That distinction matters because it guides treatment decisions.

What Are the Treatment Options?

Treatment is not always necessary. Many people with mild pectus excavatum live healthy, active lives without any intervention. The decision to treat depends on symptom severity, the degree of the depression, and the person’s own concerns.

Nonsurgical Treatment

For mild cases, doctors may recommend observation. Regular checkups ensure the condition does not worsen during growth spurts.

Physical therapy can help with posture and breathing mechanics. It does not change the shape of the sternum, but it can strengthen the chest and back muscles. Some people find that better posture makes the depression less noticeable. No clinical evidence currently confirms that exercise alone can correct the bone and cartilage deformity.

The vacuum bell is a device that fits over the chest and uses suction to pull the sternum outward. Some studies suggest it can produce mild improvement when used consistently over many months. The evidence is limited, and results vary widely. It is not a standard treatment for severe cases, and it works best in younger people with flexible chest walls.

Surgical Treatment

Surgery is reserved for moderate to severe cases, especially when symptoms like shortness of breath or chest pain are present. It is also considered when the Haller index is high, indicating significant compression of the heart and lungs.

Two main surgical techniques are used:

• Nuss procedure — A curved metal bar is inserted behind the sternum through small incisions on the sides of the chest. The bar pushes the sternum outward. It stays in place for about two to three years, then is removed in a second procedure. This is the most common technique today.
• Ravitch procedure — This is an open surgery. The surgeon makes an incision down the center of the chest, removes the abnormal cartilage, and repositions the sternum. It is used less often now but may be preferred in certain cases, such as when the chest is very asymmetric.

Both procedures are major surgeries requiring general anesthesia and a hospital stay. Recovery takes several weeks, and full return to sports or heavy lifting takes several months. Most people who have surgery report significant improvement in exercise tolerance and appearance, but the procedure carries risks like any major operation, including infection, bleeding, and the possibility that the bar shifts position.

What Happens Without Treatment?

For most people, pectus excavatum does not get worse after growth stops. The chest shape stabilizes in early adulthood. If no symptoms are present by then, they are unlikely to develop later.

For people with moderate to severe depression, the long-term outlook is less clear. Some research suggests the compression on the heart and lungs can contribute to reduced exercise capacity over time. However, it is not accurate to say that untreated pectus excavatum causes serious health problems in most cases. Many adults live with the condition without ever knowing it affects them.

Psychological effects are real and should not be dismissed. Many teenagers and young adults feel self-conscious about the appearance of their chest. This can affect social activities, swimming, and body image. Addressing these concerns is a valid part of treatment planning, even when physical symptoms are mild.

Can Pectus Excavatum Be Prevented?

No. Because the condition develops during fetal growth and becomes more pronounced during adolescence, there is no known way to prevent it. If you have a family history, knowing the signs can help with early recognition, but early recognition does not change the course of the condition. It simply allows for earlier monitoring and discussion of treatment options.