Pectus excavatum is a chest wall deformity where the breastbone (sternum) and several ribs grow inward, creating a depression in the chest. Often called “sunken chest” or “funnel chest,” its severity ranges from a slight dip to a deep indentation, affecting its appearance. While some individuals are born with it, the condition may become more apparent during periods of rapid growth, such as adolescence.
Natural Progression of Pectus Excavatum
Spontaneous resolution of pectus excavatum is uncommon. While some studies have observed improvement or even disappearance in some cases, the overall progression is unpredictable. The indentation often becomes more pronounced during growth spurts, especially during early teen years and puberty.
The condition generally stabilizes once growth finishes. However, for some, the depth of the chest indentation may increase with age, due to aging and the chest wall’s decreasing ability to compensate. This can lead to new or worsening symptoms in adulthood.
When Pectus Excavatum Requires Attention
While pectus excavatum is often a cosmetic concern, it can also lead to physical symptoms requiring medical evaluation. The inward growth of the sternum can compress the heart and lungs, affecting their function. This compression may cause shortness of breath, especially during exercise, or reduced stamina.
Individuals might also experience chest pain, irregular heartbeats, or heart palpitations due to the pressure on the heart. In severe cases, lungs may not fully expand, and the heart might be displaced, impacting its pumping efficiency. Beyond physical effects, the visible deformity can also lead to psychological impacts like body image issues and reduced self-esteem, particularly in adolescents.
Management and Treatment Options
When pectus excavatum does not resolve or leads to symptoms, various management and treatment options are available, from non-surgical to surgical interventions. Non-surgical methods are considered for mild cases or when surgical correction is not desired. Physical therapy can help improve posture and increase chest expansion through targeted exercises.
Vacuum bell therapy is another non-surgical option for children and younger teens with pliable chest walls. This involves placing a cup-shaped device on the chest that uses suction to pull the breastbone forward. Consistent use, for one or more hours daily over 12 to 15 months, aims to reshape the chest wall. While initial results can be good, long-term outcomes are still being evaluated.
For purely cosmetic concerns in mild cases without significant symptoms, dermal fillers or silicone implants can fill the sunken area.
For moderate to severe cases, or when symptoms are present, surgical interventions are often most effective. The two primary surgical procedures are the Nuss procedure and the Ravitch procedure. The Nuss procedure is a minimally invasive technique where a curved metal bar is threaded under the breastbone through small incisions on each side of the chest. The bar is then rotated to push the sternum outward. It is typically removed after two to three years.
The Ravitch procedure is a more traditional, open surgical approach. This involves making a horizontal incision across the mid-chest, removing deformed sections of cartilage connecting the ribs to the sternum, and repositioning the sternum. The choice between these procedures depends on factors such as patient age, deformity severity, and the surgeon’s expertise. Both procedures improve physical symptoms and cosmetic appearance.