Pectus Excavatum

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Pectus Excavatum is a chest deformity that affects about 1 in 500 individuals. Cosmetically, it looks like a sunken chest and is often colloquially called “funnel chest.” Anatomically, it is characterized by an abnormal sternum (breast bone) and corresponding intercostal cartilage (which connect the ribs to the sternum). Specifically, the sternum is pointed inwards and the cartilage have inversed concavity. Pectus Excavatum has a wide range of severity. It can be barely noticeable in some individuals, and in others, it can be so severe that the ratio of the width to depth of their chest (called the Haller index) leaves almost no space for the internal anatomy.

The cause of Pectus Excavatum is currently unknown. While it is genetic in at least some individuals, in other individuals, it is seemingly unannounced – it sometimes doesn’t appear until an individual hits their growth spurt. In other cases, parents usually notice the deformity when the child is only a few months to a few years old. The condition is 4 times more likely to be in males.

Individuals with Pectus normally do not experience symptoms associated with the condition. However, there are considerable physiological and psychological signs that may lead an affected individual to seek treatment:

  • shortness of breath
  • compressed heart
  • decreased lung capacity
  • exercise intolerance
  • chest pain
  • psychological trauma from a body deformity (for example, not taking a shirt off in public)

Treatment options are limited. There are both surgical options and non-surgical options, however the non-surgical options are very new and have not been proven to be effective long-term. These include exercises of the chest muscles and a vacuum pump, normally used for many hours each week, that temporarily “pops” out the chest. These options are generally only useful, if at all, for individuals with a low-severity Pectus. Surgical options are the only choice for most patients. These include the Ravitch procedure, in which the sternum is broken and the ribs are reattached, and the Nuss procedure, in which one or more metal bars are inserted across the chest to stabilize and pop out the chest. Both surgeries are very painful and are usually recommended to younger patients (during the teenage years) to minimize the risks and the recovery process.

Nuss Procedure

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