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There are two types of pectus disorders: pectus excavatum and pectus carinatum. Levine Children’s Hospital offers surgical and non-surgical options to treat children with both types of disorders, or physical deformities of the chest.

Pectus, while typically not life-threatening, can affect your child’s quality of life, and in some cases their heart and lung function. Our doctors are experts in chest wall deformities. They have published extensive research and scholarly articles, and have taught courses worldwide related to chest wall disorders.

To correct pectus, we offer brace therapy as well as the Nuss procedure. Our doctors are considered experts of the minimally invasive Nuss procedure and they train doctors throughout the nation to perform it.

Pectus Excavatum

Also known as sunken chest or funnel chest, pectus excavatum is the most common of the two disorders.

Defects in the cartilage that attaches the ribs to the breast bone cause a child’s chest to sink inward. This often hereditary condition occurs in about 1 out of 400 to 1,000 children. It is four times more common in boys than girls and can be detected within a year of birth, but more than half of reported cases are not found until the child reaches puberty.

Severe cases of this type of pectus can impair heart and lung function, cause chest pain and endurance problems, and can have a negative effect on your child’s self-esteem and social development.

Diagnosis of Pectus Excavatum

Patients with a pectus excavatum will get a complete physical that could include chest imaging, electrocardiograms, echocardiograms, metal allergy testing and other tests of the heart and lungs.

Treatment of Pectus Excavatum

For children with mild cases of pectus excavatum – and those too young for surgery – we recommend aerobic exercises that help strengthen the chest and back, and improve posture. We will closely follow your child until they either meet criteria for surgery or turn 21, at which point any further progression of the disorder would be extremely rare.

For children with severe pectus excavatum, we recommend surgery to relieve pressure on the heart. We offer a variety of options but the minimally invasive Nuss procedure is most common. The ideal time to perform the Nuss procedure is when a child is between the ages of 11 and 14. However, the procedure has been used for older patients and adults with equally successful results.

About the Nuss procedure

  • The surgeon inserts a curved metal bar under the ribs and sternum to reshape the chest wall
  • The bar stays in for two to three years and is then removed during an outpatient procedure
  • Patients typically stay in the hospital four to five days; some leave in three days
  • After six weeks, patients can perform basic daily activities
  • After three months, patients can resume all activities, but we recommend avoiding varsity level high-contact sports, such as football and ice hockey where repetitive hard blows to the chest occur

Pectus Carinatum

Pectus carinatum, or pigeon chest, is a deformity of the chest that causes the sternum and ribs to stick outward. Although similar to pectus excavatum – in that boys are four times more likely to have it than girls – pectus carinatum is about 10 times less common in the United States.

Generally, the majority of patients do not display any symptoms except for tenderness and intermittent pain over the area of abnormal cartilages. In some rare cases, patients complain of trouble exercising and playing sports but this is not common for pectus carinatum.

Diagnosis of Pectus Carinatum

Patients with pectus carinatum will get a complete physical, as well as a chest X-ray and other heart and lung evaluations, depending on the findings.

Treatment of Pectus Carinatum

There are a variety of non-surgical therapies available to help patients manage pectus carinatum, including custom-fitted braces.  For patients who are not candidates for the brace, there are surgical options available.

You may have to wait until your child is done growing to see result from braces, but they have a success rate of 75-80 percent in compliant patients.


Surgical repair may be offered if external bracing fails or can’t be used. The open approach, or the Ravitch procedure – used to correct complex cases of pectus carinatum – is the most universally accepted technique for treating patients with a pectus carinatum.