Bone, Joint and Muscle Conditions

Pectus Excavatum

What is pectus excavatum?

Pectus excavatum (PECK-tuss ex-kuh-VAW-tum) is a condition that causes a child’s chest to look sunken or "caved in." It happens because of a defect in the tough connective tissue (cartilage) that holds the bony part of the ribs to the breastbone. The cartilage pushes the breastbone (sternum) inward. The condition is also called “sunken chest” or “funnel chest.”

Pectus excavatum may be mild, moderate or severe. The lower half of the breastbone may press on the heart and lungs. This can cause shortness of breath with exercise. The opposite condition, called pectus carinatum, is when the chest bows outward.

Children with pectus excavatum sometimes also have scoliosis. Rarely, they also have Marfan syndrome.

Pectus Excavatum at Seattle Children’s

Our surgery team at Seattle Children’s has seen hundreds of children with pectus excavatum. This experience helps us correctly diagnose your child’s condition and work with you to decide on the best treatment. If your child needs surgery, we offer an option that greatly reduces their pain and hospital stay after the operation.

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information. We see patients in clinics in Bellevue, Everett, Federal Way, Seattle and Tri-Cities.

    • Each year we assess dozens of children for pectus excavatum. Even though we are experts at surgery, in many cases we decide that surgery is not needed. Our board-certified pediatric surgeons are specially trained to treat children with pectus excavatum and other chest wall problems.
    • For children who need an operation, our pediatric surgery team has lots of experience doing the operations that correct this problem. Seattle Children’s was the first hospital in the Pacific Northwest to offer the Nuss procedure, starting in 2000. We use that procedure most often.
    • Managing your child’s pain is critical to their healing. Seattle Children’s has the largest team of anesthesiologists who treat only children.
  • Our surgeons are on the forefront of treating patients with pectus excavatum. We are the first hospital in Washington to offer a nerve-freezing technique called cryoablation as part of treating pectus excavatum. With cryoablation:

    • Length of hospital stay has been reduced to 1 to 3 days
    • Patients need less than half as much narcotic pain medicine after surgery
    • 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.
    • We take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.
    • At Seattle Children's, we work with many children and families from around the Northwest and beyond. We can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Pectus Excavatum

You may see a small dent in your child’s chest when they are of grade school age. Often it gets worse at about the time a child starts puberty (age 12 to 14 years).

Pectus excavatum does not always cause other symptoms, especially before the teen years. Moderate-to-severe cases can cause:

  • Shortness of breath with exercise
  • Trouble breathing when playing certain musical instruments like brass or woodwind
  • Concern with body image

Breathing symptoms may happen when the breastbone becomes more indented and nudges the heart to the left.

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 have tests to assess their heart and lungs. These tests can help doctors decide if your child needs treatment:

  • CT scan (computed tomography scan, sometimes called “cat scan”)
  • Lung function test to check breathing patterns (sometimes done during exercise)
  • Rarely, an ultrasound of the heart (also called echocardiogram or “echo”)

Treating Pectus Excavatum

Many children with pectus excavatum have normal, active childhoods and full healthy lives without treatment. In more severe cases, children may stop playing sports and other activities that involve running or stamina. Some children without symptoms want treatment to help them feel better about their body.

No medications or physical exercises have ever been shown to improve pectus excavatum. At this time, surgery is the only option that works. Our surgery team has seen hundreds of children with pectus excavatum and can help you decide the best options for your child.

For children who need surgery, we almost always place a bar inside the chest to push up on the indented breastbone. This is called the Nuss procedure. In some cases, we use the Ravitch repair procedure.

  • The Nuss procedure takes about 2 hours.

    • 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 their 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.

    We offer a new technique that can reduce pain after surgery by more than half. It is called “cryoablation.” We freeze the nerves below each rib near where the bar is placed. This stuns the nerves for 6 to 8 weeks. Cryoablation has been shown to greatly reduce pain and to shorten the length of the hospital stay by more than half.

    It takes most children 2 to 3 months to heal. Most of the time doctors leave the bar in place for 2 years. A surgeon will remove the steel bar during a day surgery. Your child will not need a hospital stay.

  • The Ravitch repair takes 4 to 6 hours. The surgeon:

    • Removes the abnormal cartilage
    • Moves the breastbone into a normal position
    • Places a short steel bar behind the breastbone to keep it in place

    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 a day surgery. Your child will not need a hospital stay.

  • After either procedure, your child will be in the recovery room for an hour. They will stay in the hospital for 1 to 3 days if they have cryoablation and 4 to 7 days without it.

    Before your child goes home, we will teach you:

    • How to give them pain medicine
    • How to care for the incision by keeping it clean and dry
    • Guidelines on activity while your child recovers

    About 2 to 3 weeks after surgery, your child will see the surgeon for a follow-up visit. We make sure the incision is healing and that your child is recovering well.

Contact Us

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information.

To make an appointment, you can call us directly or ask your child’s primary care provider to refer you. We encourage you to coordinate with your primary care provider when coming to Seattle Children’s.

We have clinics in Bellevue, Everett, Federal Way, Seattle and Tri-Cities.

Providers, see how to refer a patient.