KidsMD Health Topics

Pectus excavatum

  • Overview

    Jay M. Wilson, MD, senior associate in Boston Children's Hospital's Department of Surgery

     Here’s what you should know about pectus excavatum (also known as "funnel chest"):

    • Pectus excavatum is a deformity of your child's chest wall where there's a depression in the breastbone.
       
    • It occurs in approximately 1 out of 500 children. It is four times more common in boys than girls, and can run in families.
       
    • A severe case may cause breathing problems, but a shallow excavatum is unlikely to cause any health problems.
       
    • While some children with pectus excavatum don’t need any treatment at all, more severe cases can be surgically repaired, allowing your child to lead a normal, active life.
       
    • Pectus excavatum is not a life-threatening condition, and most children grow up to lead normal and active lives.

    Pectus ExcavatumPectus Excavatum

    How Boston Children’s Hospital approaches pectus excavatum

    Boston Children’s General Surgery Program evaluates and treats infants, children and young adults using state-of-the-art operative methods to improve the quality of life for each child entrusted to our care.

    Our surgeons prefer to operate on children with pectus excavatum, if they operate at all, during the child's teen years. By then, they're through most of their growth spurts so recurrence is far less likely.

    Pectus excavatum: Reviewed by Jay Wilson, MD
    © Boston Children’s Hospital; posted in 2012

    Boston Children's Hospital 
    300 Longwood Ave
    Boston MA 02115

     617-355-7800
  • In-Depth

    What is a pectus excavatum?

    Pectus excavatum is a deformity of your child's chest wall. The breastbone, or sternum, and some of the ribs grow abnormally, causing a depression in the middle of the chest.

    When does pectus excavatum become apparent?

    The condition is not always noticed at birth, but is often apparent by the time a child is 2 to 3. In some cases, the condition only appears as your child grows.

    How serious is it?

    The level of severity goes from extremely mild and almost unnoticeable to severe, but the condition does tend to get worse during growth spurts.

    What kinds of health problems does a pectus excavatum cause?

    While many children with pectus excavatum don’t require any treatment at all because their condition is so mild, a more severe case can press on the heart and lungs. However, these effects on the heart and lungs are usually minor and usually only with extreme exercise.

    Also, approximately 15 percent of children who have pectus excavatum end up developing a condition called scoliosis (curvature of the spine).

    Causes

    What causes pectus excavatum?

    We don't really know. Some studies investigating a genetic component are underway. Although the majority of cases don't involve a family history, there are many that do—enough to warrant the suspicion that genes may play a significant role.

    If your child does develop scoliosis, the Spinal Program at Boston Children’s is one of the nation’s foremost pediatric treatment and research centers.

    Signs and symptoms

    What are the symptoms of pectus excavatum?

    It depends on when the condition is diagnosed.

    In infancy, symptoms of pectus excavatum can include:

    • a hollow depression in the chest that may be broad and shallow, deep and narrow, or irregular
    • more rapid breathing than normal

    In older children, symptoms of pectus excavatum can include:

    • shortness of breath upon exertion or exercise
    • chest pain
    • a lateral curvature of the spine, absence of the curve of the upper back, hooked shoulders and a broad thin chest

    What is my child’s long-term outlook?

    While most children with pectus excavatum don’t need any treatment at all, more severe cases can be surgically repaired, allowing your child to lead a normal, active life.

  • Tests

    How is pectus excavatum diagnosed?

    Pectus excavatum is usually diagnosed with a physical examination. X-rays of the chest can be helpful, as well.

    Other tests your child's doctor might recommend include:

    • Electrocardiogram (ECG or EKG) — a test that records the electrical activity of your child's heart, shows abnormal rhythms and detects heart muscle stress
       
    • Echocardiogram (echo) — a test that evaluates the structure and function of your child's heart by using sound waves recorded on an electronic sensor that produces a moving picture of the heart and heart valves
       
    • Pulmonary function test (PFT) — a test that gives your child’s doctor information about how well his lungs are working

    After we complete all necessary tests, Boston Children’s experts will meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options for your child.

  • When is the best time to do the surgery for pectus excavatum?

    Twenty-five years ago, surgeons operated when the child was as young as 4. The cartilage content of the bones made repositioning easier and healing was faster. But too often, the condition would recur, especially during growth spurts, so now repairs are typically done during the teenage years.

     
    Click to enlarge

    How is a pectus excavatum treated?

    For mild cases of pectus excavatum, there's really no reason for surgery. A shallow excavatum is unlikely to affect the operation of the heart or lungs at all, and your child's appearance will remain normal.

    If the deformity is causing physical or social problems, it can be surgically repaired. There are two options, both of which require your child to be put under general anesthesia:

    Ravitch

    • In this procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and breastbone and repositions the freed-up breastbone.
    • A bar is left in the chest wall to maintain the correct shape for six months, during which time your child has to refrain from activities that might involve a collision, like football.
    • The technique fixes the problem but leaves a scar visible on the chest.

    Nuss

    • In this procedure, the incisions are made on the side of your child's chest wall. Then the surgeon inserts a bar laterally through the chest and moves the breastbone forward.
    • No cartilage is removed.
    • Scarring is less extensive.
    • The Nuss procedure doesn't remove any asymmetry in the way your child's chest looks.
    • The bar has to stay in for at least one year, and sometimes two.

    What happens before surgery?

    You'll schedule a preoperative evaluation one to two weeks before your child's surgery. At this time you will meet with the following surgical team members:

    • Nurse practitioner who works with the surgeon
    • Nurse
    • Anesthesiologist

    During this meeting, you and your child will be able to ask any questions you might have about the surgery and the recovery process.

    What should we expect after surgery?

    Your child will go to the recovery room, and then be transferred to the surgical floor after approximately one to two hours.

    • Your child will remain in the hospital for four to six days after the surgery.
    • Your child may have a small rubber tube underneath the incision to allow any fluids to drain out. This will be removed one to two days after surgery.
    • Your child will be helped to walk the day after surgery.
    • Your child can eat/drink if feeling well the day after surgery.
    • It is not necessary to remove the stitches. They are under the skin and will dissolve on their own.

    What are the benefits of repairing my child's excavatum?

    In severe cases, repair of a pectus excavatum may help the function of the heart and lungs. But in most cases, the benefits are mostly psychological. For children who have been upset by their appearance, the surgery can make a big difference.

    What is the long-term treatment plan?

    • Your child will need to see the surgeon two weeks after surgery to make sure that the area is healing well.
    • Your child should not return to gym or participate in contact sports until after this postoperative visit with the surgeon. The doctor or nurse practitioner will give you exact instructions, but usually we recommend refraining from contact sports for up to six months after the surgery.


    Coping and support

    There are a lot of resources available for your family—within Boston Children's, in the outside community and online. These include:

    Patient education: From the very first visit, our staff will be on hand to walk you through your child's treatment and help answer any questions you may have. They'll also reach out to you by phone, continuing the care and support you received while here at the hospital.

    Parent to parent: Would you like to talk with someone else whose child has been through one of these surgical procedures? We can put you in touch with other families who can share their stories.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis and dealing with financial difficulties.

    On our For Patients and Families site, you can read all you need to know about: 

  • Research & Innovation

    The Department of Surgery

    Pectus excavatum can almost always be effectively treated with surgery. Robert Shamberger, MD, chief of the Department of Surgery at Boston Children’s Hospital, studied how surgical repair of pectus excavatum improves self-image; read more about the study here.

    The Orthopedic Center

    Approximately 15 percent of children who have an excavatum also develop scoliosis (curvature of the spine). And for more than a century, orthopedic surgeons and investigators at Boston Children’s have played a vital role in the field of musculoskeletal research, pioneering treatment approaches and major advances in the care and treatment of conditions such as scoliosis. Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—providing children with the most innovative care available.

    Boston Children's Orthopedic Center takes great pride in our basic science and clinical research leaders, who are recognized throughout the world for their respective achievements. Our orthopedic research team includes:

    • Five full-time basic scientists
    • 28 clinical investigators
    • A team of research coordinators and statisticians 

    The Clinical Effectiveness Research Center

    Boston Children's Clinical Effectiveness Research Center helps coordinate research and clinical trials to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and plays an instrumental role in establishing—for the first time—evidence-based standards of care for pediatric orthopedic patients throughout the world.

    The Spinal Program

    Physicians in the Boston Children's Spinal Program are active in several areas of ongoing basic and clinical research based at Boston Children’s and the Harvard Orthopaedics Biomechanics Laboratory. Research topics include:

    • Congenital scoliosis and idiopathic scoliosis
    • Bone density studies of braced patients

    Orthopedic Basic Science Laboratories

    Working in our basic science laboratories are some of the leading musculoskeletal researchers in the nation. Orthopedic labs include: 

Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
Contact Information
Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fields

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
close
Find a Doctor
Search by Clinician's Last Name or Specialty:
Select by Location:
Search by First Letter of Clinician's Last Name: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
BrowseSearch
Condition & Treatments
Search for a Condition or Treatment:
Show Items Starting With: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
View allSearch
Locations

Related Services

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
Close