Causes, symptoms and surgery options for pectus excavatum
On this page you’ll find out more about the following:
- What is pectus excavatum?
- What causes pectus excavatum?
- What are the symptoms?
- How is pectus excavatum diagnosed?
- Do I have mild or severe pectus excavatum?
- Does pectus excavatum shorten lifespan?
- Does pectus excavatum affect quality of life?
- What treatment options are available?
- Choosing a surgery method
- Frequently asked questions
What is pectus excavatum?
Pectus excavatum is a condition that causes the rib cage to grow abnormally and pushes the sternum inwards. People with pectus excavatum often have a sunken chest, although in severe cases it can interfere with the normal function of the heart and lungs.
What causes pectus excavatum?
There’s no clear cause of pectus excavatum but it’s thought to be a genetic condition. Studies have shown that a family history of the condition is present in up to 43% of cases1,2.
Pectus excavatum is sometimes associated with other conditions including:
- scoliosis (sideways curvature of the spine)
- kyphosis (outwards curvature of the spine)
- Marfan syndrome—a disorder that affects the connective tissues3
What are the symptoms of pectus excavatum?
In many cases, people who have pectus excavatum won’t experience any symptoms other than the appearance of their chest and won’t need surgery to correct the condition.
In more severe cases, people with the disorder may experience the following symptoms, which may require surgery to correct:
- Chest pain
- Heart problems
- Breathing problems
Chest pain is one of the most common symptoms of pectus excavatum, with 68% of patients reporting it4. The exact cause of the chest pain is unknown, but studies show that patients experience chest pain as they get older, rather than when they’re children5.
It’s thought that chest pain could be caused by:
- the restrictive effect that pectus excavatum has on the heart and lungs6
- the way the chest muscles cross the chest to attach the ribs to the breastbone7
Heart and lung problems
Some people with severe pectus excavatum may find that their heart and lungs aren’t functioning as they should.
As the chest wall and ribs press on the heart and lungs, this can make it difficult for the heart to pump blood effectively and, in some cases, for the lungs to take in oxygen8. This can reduce cardiovascular endurance and lead to shortness of breath, which can affect your ability to exercise9 and make you feel more fatigued10.
Another symptom of the sternum pressing on the heart is an increase in heart palpitations11.
Other symptoms of pectus excavatum
The ‘typical look’ of a person with pectus excavatum includes:
- slouched, forward-facing shoulders
- a curved spine
- flared ribs
- a protruding abdomen, sometimes known as a “pot belly”
Although it’s not known if having poor posture contributes to making pectus excavatum worse, it can make the condition look worse12.
Pectus excavatum is often present in people with scoliosis, a condition that causes the spine to curve sideways. In a paper by Dr. Donald Nuss (who pioneered the Nuss procedure to correct pectus excavatum), he describes how “Scoliosis was found to be present in just over 30% of our patients…”13.
Around 15% of patients with pectus excavatum also have symptoms of Marfan syndrome14, a connective tissue disorder. Other symptoms of Marfan syndrome include loose and flexible joints, eye problems and cardiovascular issues15.
Ehlers-Danlos syndromes are a rare group of conditions that can be associated with pectus excavatum. The conditions primarily affect the connective tissues. In one study of 557 patients, Ehlers-Danlos syndromes were present in 2.1% of patients with pectus excavatum16.
If you don’t have any of the above symptoms but are concerned about the appearance of your chest, you could consider pectus excavatum implant surgery to improve your chest’s appearance.
How is pectus excavatum diagnosed?
Usually, a visual examination is enough to diagnose pectus excavatum. To find out the severity of your pectus excavatum and whether it has an impact on your heart and lungs, you’ll need to have several tests. These may include the following:
- Chest x-ray
- CT (computerised tomography) scan
- Echocardiogram of the heart (similar to an ultrasound)
- Lung function tests
- Exercise test
Pectus excavatum is usually diagnosed in childhood but many people don’t realise they have it until they are teenagers or older. Patients who are diagnosed at a later age can still have surgery to correct the deformity if it’s affecting their quality of life.
Do I have mild or severe pectus excavatum?
Pectus excavatum is categorised according to severity, from mild to moderate to severe. Medical experts evaluate each case on its own merits, after the patient has had a series of tests.
You’ll need to have a CT scan to determine the severity of your pectus excavatum. Images from a CT scan are used to ascertain your Haller index, which measures the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum. A normal Haller index is around 2.5 but people with severe pectus excavatum can have an index as high as 5.517.
If you have mild or even moderate pectus excavatum, you probably haven’t noticed any symptoms other than how your chest looks. If you have severe pectus excavatum, you may experience more serious symptoms if the deformity is affecting how your heart and/or lungs function.
People with severe pectus excavatum may choose to correct the deformity with surgery, as this can improve quality of life.
Does pectus excavatum shorten lifespan?
There has been only one medical study investigating the lifespan of patients with pectus excavatum.
The study of nearly 51,000 autopsies revealed that the 62 people who had pectus excavatum tended to die at a younger age. However, it’s very important to note that of the patients who died early, 21 had co-existing conditions or syndromes and this is likely to be the cause of early death not the pectus excavatum itself. Also, the study didn’t focus on patients who had pectus excavatum but suffered no other conditions or syndromes.
The study revealed that the patients with pectus excavatum who lived past 56 actually had a longer lifespan than people without pectus excavatum18.
Yet there’s a distinct lack of research on this subject, so until further studies are conducted it isn’t clear whether pectus excavatum does affect lifespan.
Does pectus excavatum affect quality of life?
In many cases, people with pectus excavatum have no symptoms and find the condition has no impact on their quality of life.
This isn’t the case for everyone though. Some people may find the condition affects their quality of life in two ways, especially if they have severe pectus excavatum:
- Physical symptoms such as pain, heart problems and issues with breathing
- Self-image issues such as feeling self-conscious about the appearance of their chest
If you feel the condition is harming your quality of life, speak to your GP. They will be able to refer you for tests to assess the severity of your condition and whether you’d be a good candidate for surgery.
You can find out more about surgical repair for pectus excavatum with our guide The costs, risks and results of pectus excavatum surgery for adults.
What are the treatment options for pectus excavatum?
Pectus excavatum repair involves invasive surgery, a hospital stay and a long recovery period which requires pain medication. However, for many people, having surgery can improve their quality of life.
One study showed that corrective surgery led to patients having an “improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre- to post-surgery.”19
Surgery isn’t readily available on the NHS20 and can be very expensive if you choose to have the procedure done privately. You’ll also need to consider the risks and complications associated with having surgery.
A Nuss procedure consists of a surgeon inserting a metal bar through an incision on each side of your chest. Once the bar is inside, the surgeon flips it over, forcing the sternum outwards.
After surgery, the bar must stay in place for at least three years, depending on the severity of your condition and your age. After this time, it will need to be removed, which requires a further procedure. Some cases, patients will have the bar left in place permanently.
The Ravitch procedure consists of a surgeon removing small sections of chest cartilage, repositioning the ribs and sternum. Steel bars are then used to hold the sternum and ribs in place.
One option that’s more affordable and much less invasive is implant surgery for pectus excavatum. The techniques required for implant surgery involve producing a purpose-built implant to replicate the missing contour of the ribs. This provides a more normal appearance of the chest and in females the breast shape and symmetry.
You can read more with about implant surgery in our Step by Step guide to pectus excavatum implant surgery.
What are pectus excavatum implants?
Prosthetic implants for pectus excavatum are bespoke and are designed to fit the concave area of the chest exactly. A 3D computer model of your torso is created to determine the size of the implant, which will be identical to your anatomy. Manufacturers will then create a custom-made implant out of silicone rubber.
You can read more about how pectus excavatum silicone implants are made in our guide Pectus Excavatum Silicone Implants: What They Are And How They’re Made.
Choosing a surgery method
It can be helpful to compare the cost, risks and results of each surgery method before deciding on which surgery method to choose. If you would prefer a minimally invasive surgery method, pectus excavatum implant surgery may be ideal for you.
You can find out more about the surgical repair options available—including a comparison of costs and recovery time—with our guide The costs, risks and results of pectus excavatum surgery for adults. This covers the different surgical techniques used to treat the condition.
How successful is pectus excavatum surgery?
The majority of patients who have corrective surgery for pectus excavatum experience positive results (source). In one study, all but one of the 383 patients who had the Nuss procedure reported feeling happy with the outcome (source).
You can read more about the results of pectus excavatum surgery here.
Other treatment options
Pectus excavatum can be treated without surgery but results can be mixed and take a long time to achieve.
For example, vacuum bell treatment uses a device to lift the sunken area of the chest upwards. However, it can take many months, or even years, to achieve a permanent change21.
The results of vacuum bell treatment depend on the severity of the condition and the patient’s age22.
You can read more about vacuum bell treatment in our guide What is vacuum bell therapy and does it cure pectus excavatum?
In milder cases, the appearance of pectus excavatum can be improved through practicing frequent exercises. You can read more about exercises for pectus excavatum here.
Frequently asked questions on pectus excavatum
Do I have pectus excavatum?
The obvious sign that you may have pectus excavatum is a sunken chest. Often the sternum bends inwards and this causes the bottom of the ribs to flare out. Pectus excavatum is typically easier to spot in adult men rather than women, as a woman’s breasts can help to disguise the severity of the condition.
If you’re unsure whether you have pectus excavatum or how severe your condition might be, speak to your GP for a diagnosis. If they believe your case is severe, or if you’re experiencing pain or shortness of breath, they may refer you for more tests.
When is pectus excavatum a problem?
Pectus excavatum is only really a problem if you’re bothered by symptoms or if you feel self-conscious about the appearance of your chest. If you’re happy with how you look and have no symptoms, the condition is unlikely to trouble you.
If you don’t have any symptoms that affect your heart or lungs but you’re self-conscious about how your chest looks, you may be a good candidate for implant surgery. You can find out more about implant surgery in our guide Pectus excavatum implant surgery: explaining the procedure, results and cost. Our step by step guide to pectus excavatum implant surgery provides a full guide of the process.
Is pectus excavatum common?
Pectus excavatum is one of the most common chest wall deformities. It affects around one in 300–400 live births and is four times more common in men than women23.
Can you die from pectus excavatum?
There’s no clear evidence that pectus excavatum can shorten your lifespan. There are risks associated with surgical procedures to correct pectus excavatum so it’s important to be aware of these if you’re considering undergoing surgery to repair the condition.
Is pectus excavatum a birth defect?
Pectus excavatum is often present at birth but typically worsens during adolescence. As the severity of the condition can vary, some people may not realise they have pectus excavatum until they are teenagers or even adults24.
Can exercise fix pectus excavatum?
In milder cases of pectus excavatum, exercise can sometimes help improve the appearance of the physical defect.26 This involves practising strength training and body building exercises.
Can pectus excavatum cause heart problems?
In severe cases, it is possible for pectus excavatum to cause heart problems.
Is pectus excavatum genetic?
Studies have shown that a family history of the condition is present in up to 43% of cases25.
If you want to find out more about what pectus excavatum is, how implant surgery is performed and how Stephen McCulley can help you, contact the clinic today on 0115 962 4535 or email firstname.lastname@example.org.