A chest that caves inward is called pectus excavatum, sometimes referred to as “funnel chest” or “sunken chest.” It happens when the breastbone (sternum) grows inward instead of lying flat, creating a visible dip or hollow in the center of the chest. The condition affects up to 8 out of every 1,000 newborns and is three to five times more common in males than females.
Most people notice it in childhood, and it can range from a barely visible dent to a deep depression that presses on the heart and lungs. Whether it causes physical symptoms depends almost entirely on how deep the indentation is.
What Causes the Chest to Cave In
Pectus excavatum develops when the cartilage connecting the ribs to the breastbone grows unevenly, pulling the sternum inward. The exact reason this happens isn’t fully understood, but it runs in families, suggesting a strong genetic component. It can also appear alongside connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome, conditions where the body’s structural proteins don’t form correctly.
The indentation is often visible at birth or within the first year of life, but it frequently becomes more pronounced during the growth spurts of puberty. Some people go through childhood with a mild dip that deepens significantly in their teenage years.
How It Affects the Heart and Lungs
In mild cases, pectus excavatum is purely cosmetic and doesn’t interfere with organ function at all. In more severe cases, the sunken breastbone physically compresses the structures behind it. The lungs may not have enough room to fully expand, and the heart can be pushed to the left side of the chest, reducing how efficiently it pumps blood.
This compression produces a recognizable set of symptoms: shortness of breath during exercise, chest pain or pressure, a racing heart rate, fatigue, and a loss of endurance that tends to worsen over time. Some people don’t realize these symptoms are connected to their chest shape. They assume they’re simply out of shape or have exercise-induced asthma, when the real issue is that their organs are being physically crowded.
The Psychological Side
For many people with pectus excavatum, the emotional impact is just as significant as any physical symptoms. Research comparing patients with chest wall deformities to a control group found that body image was “highly disturbed” in patients before surgical correction, with scores differing significantly from people without the condition. That body image distress was strongly linked to lower self-esteem and reduced mental quality of life.
This matters because it shapes real decisions. Avoiding swimming, refusing to take off a shirt, or withdrawing from social situations are common patterns, especially in teenagers and young adults. Studies suggest body image concerns may actually drive the decision to pursue treatment more often than physical restrictions do.
How Severity Is Measured
Doctors use a CT scan or MRI to measure the depth of the indentation and check whether the heart or lungs are being compressed. From those images, they calculate something called the Haller index, a ratio that compares the width of the chest to the distance between the breastbone and the spine at the deepest point of the dip.
A person without pectus excavatum has a Haller index around 2.5. A score of 3.25 or higher is considered moderate, and surgery becomes an important consideration at that threshold. The higher the number, the more severe the compression. An echocardiogram (an ultrasound of the heart) is also commonly ordered to see whether the chest wall is affecting how well the heart pumps blood, and lung function tests can measure whether breathing capacity is reduced.
Non-Surgical Treatment
For milder cases, or for people who aren’t ready for surgery, a device called a vacuum bell can gradually lift the breastbone outward over time. It works like a large suction cup placed over the chest, creating negative pressure that slowly reshapes the depression. A 15-year study of vacuum bell therapy found a success rate of about 52% among patients who completed treatment. Spending more time wearing the device each day, using it overnight, and committing to a longer total treatment duration all improved outcomes significantly.
Older patients with stiffer chest walls can still benefit, though they typically need longer treatment periods. The vacuum bell is also sometimes used as a bridge while patients wait for surgery, helping reduce the depth of the indentation in the meantime.
Surgical Options
Two main surgical approaches exist for pectus excavatum. The Nuss procedure, introduced in 1998, is minimally invasive. A curved metal bar is inserted through small incisions on either side of the chest and positioned behind the breastbone to push it outward, almost like an internal brace. No cartilage is removed and no bone is cut. The bar stays in place for two to three years while the chest remodels around it, then it’s removed in a second, shorter procedure.
The older approach, called the Ravitch procedure, is an open surgery that involves removing sections of the overgrown cartilage and cutting the breastbone to reposition it. It’s been used since 1949 and is sometimes preferred for adult patients or people with asymmetric deformities that the Nuss bar can’t address as effectively.
Both procedures were originally designed for children before puberty, but they’re now routinely performed on adolescents and adults. In a large review of over 1,400 patients, about 80% were pediatric and 20% were adults.
What Recovery Looks Like
After the Nuss procedure, most patients stay in the hospital overnight. The first few weeks involve managing pain and avoiding movements that could shift the bar, particularly twisting motions and raising the arms overhead. Heavy lifting and contact sports are off-limits for a longer stretch, but most people return to everyday activities well before the six-month mark when full recovery is typically reached.
The activity restrictions exist for a practical reason: the bar is held in place by the pressure of the chest wall itself, and forceful movements in the early months can dislodge it. Once the tissues heal and stabilize around the bar, the risk drops significantly and activity levels return to normal.