June 30, 2025, 2:48 am | Read time: 5 minutes
Often appearing harmless from the outside, it can be more than just a cosmetic issue for those affected: Pectus excavatum is one of the most common congenital deformities of the chest. FITBOOK explains what it entails–and when treatment is necessary.
Pectus excavatum is a congenital malformation of the sternum. It is indented inward, giving the front of the chest the shape of a funnel.1 Men are significantly more affected than women, with a ratio of about four to one.2
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Overview
When does the malformation appear?
Pectus excavatum is usually first noticed in childhood. With growth, especially during puberty, the indentation can become more pronounced. In mild cases, it often causes no discomfort. However, the more severe the deformation, the more likely it is to affect not only the external appearance but also the function of the heart and lungs.3
How does pectus excavatum develop?
Pectus excavatum is caused by a disturbance in the growth behavior of the bones and rib cartilage in the chest area. In particular, the rib cartilage grows uncontrollably, causing the sternum to either curve inward–resulting in pectus excavatum–or outward, leading to a pigeon chest.
Certain underlying conditions can also promote the development of pectus excavatum. These include scoliosis, Marfan syndrome, or Poland syndrome.
- In Poland syndrome, the chest muscles and breast gland on one side of the body are underdeveloped, resulting in an asymmetrical chest shape. Pectus excavatum often occurs in this context.
- Marfan syndrome is a congenital connective tissue disorder. Affected individuals often have a sunken chest, overly long limbs, hypermobile joints, heart valve defects, and eye problems.
- Scoliosis describes a lateral, S-shaped curvature of the spine, which can lead to a depression of the chest.4
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Possible symptoms – physical and psychological
Symptoms vary greatly among individuals and depend primarily on the severity of the chest deformation. The most common physical complaints include:
- Limited physical endurance
- Shortness of breath during physical exertion
- Arrhythmias or palpitations
- Chest pain, especially with deep indentation
Psychological
Psychological stress also plays a significant role: Many feel their self-esteem is affected by the visible deformity. As a result, typical everyday places, such as swimming pools or public changing rooms, can become a major mental challenge. Some even withdraw from social situations out of shame–avoiding sports activities, groups, or changing situations. In teenagers, this can sometimes lead to social withdrawal or even depressive moods. Especially in a time when body ideals are omnipresent on social media, many affected individuals perceive their chest as a flaw, regardless of actual functional limitations.5
How the condition is diagnosed
If pectus excavatum is suspected, a pediatric practice should be consulted first. There, the medical history is taken, symptoms are recorded, and the deformity is documented with photos from various angles.
Further clarification of whether internal organs are affected involves imaging and functional examinations:
- An MRI of the chest provides the Haller index, which indicates the ratio between the transverse and longitudinal diameters of the chest. Values up to three are considered normal.
- An echocardiogram checks for possible impairments of the heart. Additionally, ECG, blood pressure and heart rate measurements, and a blood gas analysis may be performed.
- Lung function is also examined–if necessary, additionally under stress using spiroergometry.
Treatment options
Not every case of pectus excavatum requires surgery. The key factor is whether it causes functional limitations or significant distress.
Physical therapy
Especially during the growth phase, primarily during puberty, targeted physical training can help positively influence pectus excavatum and accompanying posture problems. The key is regularity. Two short training sessions per day (about 10 minutes each in the morning and evening) can already make a significant difference.
Vacuum bell therapy
What sounds like a bizarre prop is actually a recognized method for treating pectus excavatum. A flexible bell made of orthopedic silicone is placed on the indentation, and a rubber ball creates a vacuum.
With daily use, about one to three hours, the shape of the chest can gradually improve. A visible improvement is particularly noticeable in the first three months. After that, progress slows but remains stable with consistent use. The treatment usually spans about two years.
Surgery
If pectus excavatum is severe or causes discomfort, surgery can help. Two procedures have become established in practice: The commonly used “Nuss procedure” is a minimally invasive surgery where a metal bar is inserted under the sternum. This lifts the chest wall and remains in the body for about two to three years before being removed in a second procedure.
For complicated or asymmetrical deformities, doctors more frequently use the “Ravitch technique.” This involves surgically opening the chest, removing cartilaginous parts, and realigning the sternum stably.
Both procedures are considered safe today and generally achieve good functional and aesthetic results. After surgery, several weeks of rest and targeted physiotherapeutic follow-up care are required until the chest is fully loadable again.
Health insurance usually covers the costs if the severity of the deformity leads to demonstrable physical or psychological impairment.
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Conclusion: No reason for shame – but take it seriously!
Pectus excavatum is more than a visual peculiarity. For some, it remains purely cosmetic, while for others, it can cause physical and emotional issues. Early evaluation by specialists is important–as is the courage to discuss potential limitations. Modern therapeutic methods today offer many ways to significantly improve quality of life.