Bone, Joint and Muscle Conditions
What is pectus excavatum?
Pectus excavatum (PECK-tuss ex-kuh-VAW-tum) is a breastbone (sternum) and rib cartilage deformity that causes a dent in the chest. It is also called “sunken chest” or “funnel chest.” This dent is often in the lower half of the breastbone and may press on the heart and lungs.
Pectus excavatum may be mild, moderate or severe. The condition may also cause discomfort and shortness of breath. The opposite condition, called pectus carinatum, is where the breastbone and cartilage bow outward.
Pectus excavatum in children
This condition affects about 1 in 1,000 children. Boys are 5 times more likely than girls to have pectus excavatum, and the condition usually affects only 1 person in a family. Children with pectus excavatum sometimes have an associated condition, such as scoliosis or Marfan syndrome.
Pectus Excavatum at Seattle Children’s
Our highly trained surgery team at Seattle Children’s has seen hundreds of children with pectus excavatum and sees dozens of cases each year. This experience helps us easily diagnose your child’s condition and work with you to decide on the best treatment. We take a conservative approach and, in most cases, children with pectus excavatum can live a normal, active childhood without needing surgery. In more severe cases, treatment includes surgery to stop a child’s breastbone from pushing on their heart and lungs.
Our surgeons are specially trained in pediatric surgery and have special expertise in children with chest wall conditions. They have extensive experience performing the operations that correct this condition, including the Ravitch repair and Nuss procedure. Seattle Children’s was the first hospital in the Pacific Northwest to offer the Nuss procedure and has been using the technology since 2000.
Our team of experts focuses on how today’s treatment will affect your child as they develop and become adults. We base treatment plans on years of experience and the newest research on what works best – and most safely – for children and teens. This experience helps us easily diagnose your child’s condition and work with you to decide on the best treatment.
At Seattle Children’s, your family has a full team behind you, from diagnosis through treatment and follow-up. From our appointment schedulers to our pediatric nurses, our team is specially trained to work with children and their families. Our facilities and equipment also reflect this kid-friendly, family-centered approach.
Symptoms of Pectus Excavatum
In pectus excavatum, the cartilage that holds the ribs to the breastbone grows abnormally and pushes the breastbone inward, which causes your child’s chest to look sunken.
You might notice a dent in your child’s chest as a baby, but sometimes it doesn’t show up until later. The dent might become more noticeable as your child grows, particularly during growth spurts. Or, it might disappear and never become a problem. What often appears to be pectus excavatum in babies goes away on its own.
Pectus excavatum doesn’t always cause symptoms. Symptoms can occur when the breastbone pushes on the heart and lungs. Moderate-to-severe cases can cause:
- Shortness of breath
- Chest pain
- Trouble breathing when exercising
- Concern with body image
Diagnosing Pectus Excavatum
During your first visit to Seattle Children’s, the doctor will examine your child and ask about their symptoms. Your child may need additional tests so doctors can evaluate their heart and lungs and decide whether they need treatment. These tests might include:
- CT scan (computed tomography scan, sometimes called “cat scan”)
- Lung function test to check breathing patterns (sometimes done during exercise)
- Ultrasound of the heart (also called echocardiogram or “echo”)
Treating Pectus Excavatum
Our surgery team has seen hundreds of children with pectus excavatum and can help you decide if your child’s condition needs treatment or tests. Treatment is not always necessary. Many children live normal, healthy lives without treatment. Some children have symptoms and may need surgery to move the breastbone and make more room for the heart and lungs or to help them feel better about their body.
Surgery for pectus excavatum
The 2 main surgeries for pectus excavatum include the Ravitch repair and the Nuss procedure. Many surgeons prefer the Nuss procedure over the Ravitch repair because it requires smaller incisions, allowing faster healing.
Our surgeons will explain these procedures to help you decide which is best for your child. If your child has 1 of these surgeries, we will first give your child general anesthesia, a type of medicine that makes them sleep without pain during the surgery. Our pediatric anesthesiologists have special training in giving anesthesia specifically for kids.
During the Ravitch repair, the surgeon makes a long cut (incision) across the chest below the breast line and raises the chest muscles off the breastbone and ribs. The surgeon then removes the abnormal cartilage, moves the breastbone into a normal position and places a short steel bar behind it to keep it in place. Finally, the surgeon reattaches the muscles and sews up the incision. The Ravitch repair takes about 4 to 6 hours.
As your child heals, their cartilage will regrow and reconnect the breastbone to the ribs. After about 6 months, surgeons will remove the steel bar during an outpatient surgery, which does not require a hospital stay.
The Nuss procedure is a newer procedure where the surgeon inserts a long, stainless-steel bar that is bent to the desired shape of the chest. The bar goes under your child’s breastbone and in front of the heart. As the bar pushes the breastbone forward, it bends the cartilage that holds the breastbone to the ribs. The goal is for the bone and cartilage to heal in this new, more normal shape. The Nuss procedure takes about 2 to 3 hours.
It takes most children about 2 to 3 months to heal. Doctors usually leave the bar in place for 2 years. Surgeons will remove the bar during an outpatient surgery, which does not require a hospital stay.
What happens after my child’s surgery?
After either the Ravitch repair or the Nuss procedure, your child will be in the recovery room for another hour and will stay in the hospital for about 4 to 7 days.
Before your child goes home, we will teach you how to give your child pain medicine and how to care for the incision by keeping it clean and dry. You should also limit your child’s activity while they recover. Your child should:
- Sit up straight for the first month after surgery
- Avoid lifting anything heavy for a few months
- Avoid playing sports for 2 to 3 months
The surgery team will explain these and other limitations before your child goes home. About 2 to 3 weeks after surgery, your child will need to see the surgeon for a follow-up visit. During that appointment, the surgeon will make sure the incision is healing and that your child is recovering well.
Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information about pectus excavatum.
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