If you or your child has a chest that appears sunken or curves inward instead of outward, it may be a condition called ‘pectus excavatum’ (also known as ‘sunken chest’, ‘funnel chest’ or ‘trichterbrust 13’). It is the most common congenital (present at birth) abnormality that affects the chest wall. About 1 to 8 people per 1,000 have it. It happens more often in boys.
In most cases the causes of pectus excavatum are unknown. But some people get it as part of a connective tissue disease like Marfan syndrome or Ehlers-Danlos syndrome.
A sunken chest can affect much more than the look of the chest. It also can cause symptoms such as shortness of breath, chest pain, and a fast-beating, fluttering or pounding heart. The good news is that several effective treatment options are available today, more than even a decade ago.
Read this guide to know about what pectus excavatum is, when it needs treatment, and the range of surgical options available, including the Pectus Up implant system, a newer minimally invasive technique offered as part of our thoracic surgery programme at Asian Heart Institute (AHI).
What Is Pectus Excavatum?
Pectus excavatum is a congenital chest wall deformity in which the sternum (breastbone) and adjoining ribs grow inward, creating a depression or “caved-in” appearance in the center of the chest. People often notice it during their early teen years.
The exact cause is not fully understood, but it’s linked to abnormal cartilage growth at the point where the ribs meet the sternum.
Pectus excavatum symptoms can be both physical and psychological.
Physical symptoms are:
- Shortness of breath with exercise
- Less stamina compared to peers
- Fatigue
- Chest pain
- A fast-beating, fluttering or pounding heart
- Frequent infections of the upper airway
Psychological symptoms are:
- Significant embarrassment from the appearance of your chest
- Self-esteem issues
- Clinical depression
Why It Matters Beyond Appearance
Many people think pectus excavatum only affects appearance, but this is not always true.
In moderate or severe cases, the sunken chest can:
- Decrease the space available for the heart and lungs
- Cause shortness of breath during exercise
- Make you tire more easily during physical activity
- Cause occasional chest pain
- Affect posture
- Lower self-confidence and cause emotional stress, especially in teenagers
That’s why it’s important to have the condition evaluated by a thoracic surgeon.
How is Sunken Chest Evaluated?
A healthcare provider can start the diagnosis of pectus excavatum with a simple physical examination.
Afterward, they will perform a detailed evaluation, which may include the following:
Haller Index Calculation From a CT scan
A ratio comparing the width and depth of the chest. This helps quantify severity (an index above 3.2 is generally considered severe).
Cardiac & Pulmonary Function Assessment
Check whether the deformity is affecting heart or lung function.
Photographic Documentation
Help track progression, particularly in growing children and teenagers.
Can Pectus Excavatum Go Away?
It does not go away on its own and generally worsens during adolescent growth spurts.
Sunken Chest Treatment Options: From Observation to Surgery
Not every case requires surgery. Surgery is mainly for individuals who have moderate to severe symptoms. People with mild symptoms may get better with other treatments.
1. Non-surgical: Vacuum Bell Therapy
This is a non-surgical treatment that uses a suction cup placed over the chest.
With regular use over several months, the device gently pulls the breastbone outward.
This treatment works best for:
- Younger children
- Mild to moderate cases
- Flexible chest walls
2. Nuss Procedure (Minimally Invasive Repair)
The long-standing “gold standard” for pectus excavatum correction.
In this minimally invasive procedure, your surgeon will:
- Insert a camera into the chest to guide the procedure.
- Create two small incisions on either side of the chest.
- Insert a custom-curved steel bar(s) under your sternum and position the bar(s). This is done to elevate the sternum.
- Secure the bar to the chest wall on each side to correct the depression.
The bar typically remains in place for 2–3 years before removal in a second, shorter procedure.
3. Ravitch Procedure (Traditional or Open Procedure)
An older, more invasive technique which uses a small plate and tiny screws or a small metal bar to stabilise your sternum in its new position. A surgeon removes the bar in 6 to 12 months during a short outpatient procedure.
4. Pectus Up Implant System
A newer, extrathoracic (outside the chest cavity) technique that offers an alternative to bar-based repair for suitable candidates.
What Is the Pectus Up Implant?
The Pectus Up Implant is a newer minimally invasive surgical option. Minimally invasive surgery uses smaller surgical cuts and most often is less risky than open surgery.
The implant is placed outside the chest cavity, rather than behind the breastbone; that’s why it is different from the Nuss procedure.
Pectus Up implant surgery does not require instruments to pass close to the heart and lungs.
How Does the Procedure Work?
During surgery:
- A small incision (about 3–5 cm) is made over the sunken area.
- A specially designed implant is selected based on your CT scan and chest measurements.
- The breastbone is gently lifted into its normal position.
- The implant is secured to maintain the correction.
As the procedure is performed outside the chest cavity, that means it can offer certain advantages for selected individuals.
Possible Benefits of Pectus Up Implant:
- Smaller incision
- Minimally invasive procedure
- Surgery performed outside the chest cavity
- Reduced risk of working close to the heart and lungs
- Shorter hospital stay for many patients
- Less pain after surgery in some patients
- Customized implant size for individual chest shape
What Should You Expect After Surgery?
Like the Nuss bar, the Pectus Up implant is not intended to be permanent. It is generally removed after a period of a few years once correction has stabilised.
After surgery, you should expect:
- A short hospital stay
- Pain medication during recovery
- Gradual return to daily activities
- Temporary restrictions on heavy lifting, contact sports, and sleeping on your stomach
- Regular follow-up visits with your surgeon
Is the Pectus Up Implant Right for Everyone?
No.
Not everyone is a suitable candidate for a Pectus Up implant.
The right approach depends on:
- Age and remaining growth potential
- Severity and symmetry of the depression (Haller Index)
- Chest wall flexibility
- Whether this is a first correction or a revision of a prior repair
- Individual anatomy assessed on CT imaging
At Asian Heart Institute, every patient undergoes a comprehensive evaluation before deciding on the best suitable treatment. Based on the results and individual factors, our surgeon may recommend observation, vacuum bell therapy, the Nuss procedure, or the Pectus Up Implant or a hybrid procedure combing Ravitch procedure.
When Should You See a Thoracic Surgeon?
You should consider consulting a specialist if the chest depression appears to be worsening, especially during a growth spurt.
Immediately, contact your doctor if you experience the following:
- Shortness of breath with exercise
- Less stamina compared to peers
- Fatigue
- Chest pain
- Irregular heartbeat
- Heart palpitations
Regular checkups with an expert can help them decide when you should have an operation (or if your case is severe enough to need it).
Conclusion
Pectus excavatum — an abnormally developed breastbone — can be a frustrating condition because of its physical and emotional impact. However, it is a well-understood and treatable condition.
After detailed evaluation, your doctor can personalise your treatment, which can range from observation, vacuum bell therapy, and the Nuss procedure to a newer approach like the Pectus Up implant. This helps relieve pressure on your heart and lungs so they can work better, helping you live a quality life.
If you’re considering evaluation or treatment for pectus excavatum, our thoracic surgery team at Asian Heart Institute can walk you through which option fits your anatomy and goals.
Medical Disclaimer: This article is for general patient education. Suitability for any specific procedure — including the Pectus Up implant — depends on an individual clinical evaluation, imaging, and assessment by a qualified thoracic surgeon. It is not a substitute for a consultation.
