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What Is Pectus Excavatum

Pectus Excavatum is a common chest wall deformity. Irregular growth of the ribcage causes the inward growth of the sternum resulting with the instantly recognisable sunken chest look.

 indented chest on young male

Pectus excavatum (concave,funnel chest) is a congenital birth defect of the sternum area which hits roughly 1 in 300 – 400 births (3:1 male to female ratio). It is one of the most common chest wall deformities and it is caused by irregular growth of the ribcage and sternum during the skeletal development. More specifically, the affected anterior ribs start growing outwards which forces the breastbone (sternum) to go inward, often displacing it to one side more than the other (symmetric vs asymmetric type). Symmetrical type is when the hole is located in the center of the chest, asymmetrical is when the hole is slightly off balanced either to the left or right side of the chest. The displacement depends on which ribs are affected more during the skeletal development. If the ribs on the left side on the skeleton are pushed outwards more, than the hole in the chest will be more expressed on the left side and visa-verse.


x-ray scan of patient with concave chest

x-ray scan shows the downward orientation of the anterior rib ( red arrow) and the depressed sternum (white arrow)

The sunken chest deformity is usually present and visible at birth, so most cases can be diagnosed instantly or during the child first year of life. However, the anomaly usually starts growing and developing when the individual reaches early adolescence and is faced with rapid bone growth and body changes. In some cases, this is when the anomaly is first noticed and brought to professional medical attention. The exact causes for this deformity are still not clear, with genetics considered bigest factor. 


Is This Deformity Life Threatening ?

sunken chest depression pushes the heart to the leftSuffering from pectus excavatum is not life-threatening. In fact, until recently it was considered as a purely cosmetic defect. However, in recent years many new studies and facts have emerged and most have shown that when in severe form, it can have considerable physical and psychological effects.


Severe forms can push the heart to the left side to some degree, although usually this is not the case. Besides the heart, the sunken chest can also put pressure to the lungs, preventing them from expanding fully and reaching their full capacity. This leads to decrease in stamina and endurance, breathing difficulty and chest pain.


Although until recently there was not a broad reach of information regarding this deformity, recent studies and publications have shown that the psychological effects are a very big issue for the infected individuals. It was considered that the biggest problem patients had was negative self-image and avoiding to take their shirt off in public, but in fact, having concave chest affects the individuals in all aspects of their lives.



Is Pectus Excavatum Treatable ?

There are ways to treat the sunken chest syndrome, both surgical and non-surgical ones. If the condition is mild (Haller index < 3), then following out workout plan the condition can be masked up to 90%. But if your case is in the severe section, the only way to get full health and cosmetic result is by getting surgery. The surgery involves pushing the sternum forward in correct position and maintaining that position with a pectus bar or a metal strut. There are several kinds of surgical procedures, with the Nuss Procedure considered the best option currently. 


What is Pectus Excavatum surgery ?

Surgical correction has been shown to repair any functional symptoms that may occur in the condition, such as respiratory problems or heart murmurs, provided that permanent damage has not already arisen from an extremely severe case. But, usually, this condition is recommended to be dealt with naturally. There are many proven and tested exercises that are sure to minimise or fully recover the condition. However if the condition is severe (Haller index > 3.5), then only a surgery would get full 100% cosmetic repair. There are two main procedures for this kind of deformity, the Nuss procedure and the Ravitch. Both have the same goal, pushing the sternum outward and in correct position with the only difference in their technique. The minimally-invasive Nuss is considered more medically advanced (developed in 1987) and usually the first choice of patients, with the Ravitch (dates back  to 1949) performed on patients who are not susceptible for the Nuss.



pectus excavatum surgery illustration