Pectus Excavatum

Pectus excavatum is a deformity that occurs in approximately one out of 1,000 children.

What is Pectus Excavatum?

Pectus excavatum - also known as sunken chest syndrome - is the most common chest wall disorder treated at Nationwide Children’s. Pectus excavatum is a deformity that occurs in approximately one out of 1,000 children. It is characterized by a concavity of the sternum. The disorder is about five times more common in boys than girls and is usually noted at birth as a mild condition but can become progressively more pronounced over time.

Additional symptoms and conditions can include:

  • Chest pain
  • Shortness of breath, especially on exertion
  • Mitral valve prolapse
  • Associated syndromes affecting skeletal growth
  • Scoliosis

How is Pectus Excavatum Diagnosed?

Chest wall deformities can be evident in infancy, but many also develop or become more obvious as children grow. Abnormalities are usually noted by the parents, but may be evident only to the physician and found during routine chest examination.

Other deformities may be noted by the patient. Because the chest wall develops over time, becoming less flexible after infancy, disorders may become more or less problematic with maturation of the chest wall.

How is Pectus Excavatum Treated?

Surgical Option

For those who require treatment, the most commonly performed procedure is a minimally invasive thoracoscopic surgery to correct the deformity by placing a prosthetic bar behind the sternum, known as the Nuss procedure. The bar is removed after three years and the defect has remodeled into a more symmetrically positioned sternum. The appropriate timing of surgery is typically in the early adolescent years, but patients undergo evaluation for this condition at any age.

This minimally invasive surgery is a marked improvement over traditional open surgery for treatment of pectus excavatum, meaning several advantages to patients, including:

  • Smaller incisions and reduced scarring
  • Reduced operating time
  • An approximate 90 percent decrease in blood loss
  • An early return to regular activity
  • Excellent cosmetic results

Non-surgical Option

Patients who are looking to avoid surgery or who do not qualify for surgery have the option of choosing non-surgical treatment pairing vacuum bell therapy with exercises and stretches. Patients who choose this option typically see excellent results including:

  • Approximately 80 percent saw an elevation greater than 1 cm within 3 months
  • Approximately 20 percent saw complete correction within 6 months
  • Approximately 13.5 percent saw complete correction within 18 months


The optimal ages for chest wall deformity referrals are between 10 and 12 years. Patients are examined earlier if parents or the primary care physician have questions.

If patients are diagnosed after adolescence, they can still be examined to determine what their options are given the severity of the deformity. With any of these referrals, no pre-visit studies are needed.

Request an Appointment