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Pectus excavatum: description, treatment, course

by Josephine Andrews
Published: Last Updated on 396 views

A pectoral excavation (pectus excavatum) is a congenital malformation in which the lower part of the breastbone bulges inwards and takes on the shape of a funnel. Read here how a funnel chest develops, what symptoms occur and how it is treated!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


quick overview

  • What is a pectus excavatum? Congenital deformity of the breastbone and ribs. The sternum curves inwards at the bottom. Seen from the front, the thorax is funnel-shaped.
  • Treatment: physiotherapy, suction cup, neuromuscular muscle stimulation. Surgery is rarely necessary.
  • Course and prognosis: Pectus excavatum often becomes apparent during the first year of life and worsens with growth and puberty. With timely treatment, the prognosis is very good.
  • Symptoms: Pectus excavation rarely causes physical symptoms, such as back pain , spinal curvature, asymmetrical breasts, impaired heart and lung function. Much more often, severe mental stress is the result.
  • Causes: Disturbance of cartilage and bone growth in the area of ​​the front chest wall. How this comes about is unknown. In one third of all those affected, funnel chest occurs in families.
  • Risk factors: scoliosis , Marfan syndrome and Poland syndrome, fetal alcohol syndrome, vitamin deficiency
  • Diagnostics: Visual diagnosis, chest X-ray, magnetic resonance imaging, lung function tests, cardiac examination
  • Prevention: Since it is a congenital disease, prevention is not possible.

What is a pectus excavatum?

A funnel chest (pectus excavatum) is a mostly congenital deformation of the thorax, in which the sternum arches inwards, especially in the lower area. Viewed from the outside, the anterior chest wall is funnel-shaped. Typically, four to five ribs per side and the sternum are affected.

The sternum is sunken symmetrically or asymmetrically, depending on the case. Especially with asymmetrical forms, the breasts of affected girls and women are of different sizes and shapes.

In most cases, pectus excavatum is congenital; it rarely develops over the course of life as a result of previous illnesses or injuries.


Pectus excavation is the most common congenital deformity of the chest. On average, it affects one in 400 newborns, boys four to five times more often than girls. In about a third of all those affected, at least one other family member has a funnel chest (family cluster).

keel chest

A so-called keel breast (Pectus carinatum, chicken breast) is the opposite of the funnel breast. The sternum and the adjacent ribs do not bulge inwards in a funnel shape, but outwards. The protrusion occurs much less frequently than the depression and usually does not develop until puberty. The cause is excessive growth of the cartilage connection between the ribs and the breastbone.

People with a quill chest usually suffer from severe mental stress and improper strain on the spine (back pain, scoliosis) – but serious health problems are rare. Surgery is necessary when the keel chest is so pronounced that it restricts breathing. In all other cases, an attempt is made to continuously push back the bulging with the help of a custom-made pressure brace ( pressure bandage ).

What can you do about a funnel chest?

Whether and how a funnel chest is treated depends on the extent of the malformation and the age of the patient. Basically, a funnel chest is easily treatable.

A slight funnel chest usually does not require medical treatment, but many sufferers want it for aesthetic reasons. Reasons that speak for therapy are pronounced forms that affect the heart and lungs or cause severe mental stress.

There are different approaches to treating a funnel chest: physiotherapy, treatment with a suction cup, placing an implant or an operation.

suction cup

In the case of a slight retraction of the chest wall, treatment with a special suction cup achieves good results. It is suitable for children from about six years of age. The suction cup is made of orthopedic silicone and can be individually adapted to the patient. It is placed on the chest and creates a negative pressure that lifts the chest.

With daily use for one to three hours, the suction cup therapy lasts about three years. The effect is strongest in the first three months, from then on the funnel decreases by 1 mm per month. In addition, doctors recommend regular posture training and muscle building.

The suction cup is built in such a way that it can be worn well under clothing – even during sports. Depending on the size of the chest and the size of the chest deformity, there are different suction cups. Special models are available for girls and women during and after breast development.

physical therapy

As long as the body is growing, physiotherapy is a good way to counteract the funnel chest and the associated poor posture through physiotherapy . Whether a funnel chest can be “trained away” with exercises depends heavily on its severity.

With daily training – in the morning and in the evening for ten minutes – those affected continue to expand their chest and work on their posture. Exercises to strengthen the back and chest muscles and to expand the chest are particularly suitable for this.

Exercises to strengthen the back

  • Clasp your hands behind your head, hook your fingers together.
  • Push your elbows back as far as possible, keeping your head and neck straight. This pose brings the chest forward.
  • Bend the stretched upper body forward at the hips. Hold the position for 2-3 seconds, 25 reps. This exercise strengthens the back and brings the shoulders back.

Exercise to strengthen the chest muscles

  • Lie on your back, arms outstretched.
  • Light weights in both hands, then bring straight arms together over chest, 25 reps.
  • 25 push-ups per day (in the case of an operation only from the fourth month afterwards)

Chest expansion exercise

  • Back straight, stretch shoulders back.
  • Breathe deeply and hold your breath for as long as possible. 20 repetitions twice a day.

Exercise immediately after getting up and before going to bed and no longer than ten minutes at a time!

Endurance sports such as swimming or jogging also have a positive effect on the funnel chest.


If the funnel chest does not cause any symptoms or limitations, but is bothersome, it can be optically compensated with a custom-made implant – which is placed under the skin – or with autologous fat. However, this procedure is only performed in adulthood.

Neuromuscular Electrical Stimulation (NMES)

If the spine is incorrectly positioned, targeted neuromuscular electrostimulation is suitable to strengthen the back muscles and improve the stability of the trunk. Muscles and nerves are stimulated with small current surges.


The doctor then performs an operation if the funnel chest is very pronounced (Haller index greater than 3.2), asymmetrical or very psychologically very stressful for the person concerned.

Surgery method according to Donald Nuss: It is particularly suitable for children between the ages of twelve and 16. A metal bar is passed under the sternum, which pushes the depression in the sternum outwards and thus eliminates the funnel. The bracket is removed after three years.

Stabilization with metal plates: With this method, the doctor stabilizes the sternum with metal plates and wire sutures. They are usually removed after a year.

After the operation

After the funnel chest operation, it takes several weeks before the patient can return to his usual everyday life. The following should be observed after the procedure:

1st to 6th week after the operation:

  • The doctor will gradually stop taking the painkillers you were given after the surgery.
  • Do not raise your arms above your head for the first two weeks after the operation!
  • Sleep on your back for the first four weeks.
  • Avoid sports, walking is possible.

6th to 12th week after the operation:

  • From now on the physiotherapy begins.
  • Slowly increase your daily activities.
  • Don’t rotate your upper body!
  • Swimming, jogging, cycling and driving is possible if you are pain-free.
  • Do not carry backpacks or school bags!
  • Do not lift heavy loads over 20 kg!

After the 12th week after the operation:

  • Normal physical activity is now possible again.
  • Keep doing physical therapy regularly.
  • Permanently avoid contact sports such as ice hockey, football, boxing, wrestling or karate !

Coverage of costs by health insurance

Health insurance companies cover the cost of the diagnostics. Whether the costs for the treatment are also covered depends on how severe the physical symptoms are. Basically, the following applies: The more pronounced the funnel chest and the clearer the symptoms are, the sooner the health insurance company will cover the treatment costs.

A severe mental impairment as a result of the deformity can be proven by a mental health report. In the case of purely cosmetically motivated interventions, the patient usually bears the costs themselves. The costs for the operation amount to up to 10,000 euros, excluding hospital stay, which has to be paid additionally.

Talk to your doctor about whether your health insurance company will cover the costs of the treatment!

Is a chest funnel dangerous?

A funnel chest rarely causes physical symptoms, but often causes psychological stress. However, if the indentation is very deep, it is possible that it will displace internal organs such as the heart and lungs and limit their function. In these cases, surgery can help.

life expectancy

Since a funnel chest can usually be treated well, those affected have a normal life expectancy. If pectus excavation is a symptom of another underlying condition, life expectancy may be reduced.

How do I recognize a pectus excavatum?

The symptoms that occur depend on how severe the pectus excavation is. If the sternum sinks only slightly, there are hardly any physical symptoms. In more severe cases, however, the displacement of the heart and lungs causes the organs to malfunction. Overall, physical complaints are rather rare.

In babies, the funnel is sometimes not or only slightly visible, but it usually becomes clearly visible within the first year of life. Typically, the funnel gets worse during growth and puberty, sometimes leading to symptoms.

Symptoms triggered by Pectus Excavatum

  • Paradoxical breathing in infants (chest moves inward on inhalation and outward on exhalation)
  • Low back and back pain due to poor posture
  • chest pain
  • Drooping and hunched shoulders, protruding abdomen, hollow back, rounded back
  • Spinal curvature (scoliosis)
  • The ribs at the lower costal arch may protrude slightly.
  • Mental suffering from the aesthetic impairment: Even if a funnel chest usually does not pose a health risk, many sufferers struggle with a restriction in their quality of life. They often have little self-esteem and avoid going to the swimming pool, for example, so as not to have to show themselves shirtless in public.
  • From the outside, the patients show an indentation at the level of the nipples. This “funnel” can be both symmetrical and asymmetrical and, accordingly, stand deeper on one side than on the other. In women, there is usually an asymmetry in the breasts, which can be very stressful psychologically.
  • A pronounced funnel chest can constrict the heart and lungs. With heavy physical exertion, heart palpitations and shortness of breath occur
  • More frequent infections of the lungs and bronchi .

Sequelae of Pectus Excavation

With the onset of puberty, the funnel chest usually develops to its greatest extent. Affected people then often get caught in a kind of “vicious circle”:

  • Due to the lower resilience and pain in the chest , those affected are often less active.
  • They become more aware of the changed appearance and withdraw.
  • They avoid physical activity so that others cannot see their self-perceived flaws and increasingly become socially isolated.
  • The lack of physical activity weakens the chest and back muscles, which causes the pectus excavatum to worsen further.

Causes and risk factors

The cause for the development of funnel chest is a disturbance of the cartilage and bone growth in the area of ​​​​the chest. As a result, the costal cartilage grows uncontrollably – the sternum arches inwards (funnel chest) or outwards (keel chest). How this comes about is unclear. Since the funnel chest runs in families in one third of all patients, doctors assume a certain genetic predisposition.

risk factors

Pectus excavation is not always the only (isolated) disease; in some cases there are other diseases that promote pectus excavation:

Scoliosis: In scoliosis, the spine is curved in an S-shape to the side. As a result, the chest may collapse.

Marfan syndrome: This is a congenital disease of the connective tissue. In addition to a funnel chest, those affected often have disproportionately long arms and legs, overextensible joints, heart valve defects and eye problems.

Poland Syndrome: In Poland Syndrome, the mammary gland and pectoral muscle on one side of the body are malformed, and the affected breast is smaller than the healthy one. A funnel chest is also common.

Fetal Alcohol Syndrome : Alcohol consumption during pregnancy can cause serious harm to the unborn child: in addition to mental impairment and certain facial features, many sufferers have a funnel chest.

Vitamin deficiency: In very rare cases, the funnel chest is the result of a vitamin deficiency. Since vitamin D plays an important role in the formation of bone tissue, a permanent deficiency (rickets) leads to malformations in the skeleton, such as a funnel chest.

examination and diagnosis

The first point of contact if you suspect a funnel chest is the pediatrician. In the newborn, it is possible that the retraction of the sternum is only slightly visible or may not be visible at all. At the latest after puberty, a look at the chest is sufficient to diagnose a funnel chest. For further clarification, the doctor usually refers the patient to an orthopedist or surgeon.

First, the doctor measures the deformation and documents it with photos from different perspectives. Doctors do additional tests to determine whether the deformity is affecting internal organs, such as the heart or lungs (by crowding the organs). These include:

X-ray examination: The doctor uses X-rays (from the front and from the side) to show the bone structures.

Magnetic resonance imaging (MRI) of the chest : Cross-sectional images of the chest are made using MRI. The so-called “Haller index” is calculated by evaluating these images: It is calculated from the greatest distance between the right and left ribs, divided by the smallest distance between the breastbone and the spine. The higher the index, the more pronounced the pectoral excavation. Healthy people have an index of 2.5.

Spirometry : With the help of spirometry, lung function is examined.

Spiroergometry : Here, the lung function is tested under physical stress.

Examination of the heart: Examinations to determine whether the heart is affected by the deformation include blood gas analysis, heart rate measurement, blood pressure measurement, electrocardiogram ( ECG ) and cardiac ultrasound.


Because pectus excavatum is congenital in most cases, there are no measures to prevent the condition.

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