Chest wall disorders: When to seek treatment for pectus excavatum or carinatum


Boy swimming underwater with goggles on
Correcting a sunken or pigeon chest isn’t just a vanity thing; it can play a significant role in improving a young person’s self-esteem and, in some cases, their heart and lung function.

If you notice as your child hits a growth spurt during puberty that their chest is developing an abnormal shape, it could be caused by a chest wall deformity. The two most common types are:

  • Pectus excavatum: Also called “sunken chest,” this condition pulls the breastbone inward, giving the chest a caved-in appearance. It affects 1 out of every 500 children.
  • Pectus carinatum: Also called “pigeon chest,” this condition causes the ribs and breastbone to grow outward and make the chest jut out. It affects 1 in 1,500 children.

Chest wall deformities occur more often in boys. Google “celebrities with pectus” and you might be surprised to find that actors Jeff Goldblum, Joaquin Phoenix, Sylvester Stallone, and Grace Park have had one of these conditions. So has Dallas Mavericks basketball legend Dirk Nowitzki.

Why treat pectus conditions?

Parents have been told for years that pediatric chest wall deformities are simply a “cosmetic thing,” but research has shown that they can interfere with your child’s heart and lung function and impede their ability to participate in some daily activities and at a high level in sports. The cosmetic aspects of these conditions shouldn’t be discounted, either. Even mild cases of pectus excavatum or carinatum can make adolescents feel self-conscious about their appearance.

Whether you want to help your child breathe easier, become more active, or boost their self-esteem, there are options for treatment. At the Center for Chest Wall Anomalies and Pectus, a collaboration between UT Southwestern and Children’s Health, your child can get effective treatment, with or without surgery. We are one of the few centers in the nation to offer the Dynamic Compressor System, a custom bracing process to “dial in” the appropriate level of compression for your child.

If surgery is recommended, we will discuss the best options to correct the chest wall deformity so your child can begin to feel better as quickly as possible.

What causes pectus excavatum and pectus carinatum

No one knows exactly what causes pectus excavatum and pectus carinatum, but they do run in families and boys are affected more often than girls. The conditions may be identified in infants, but oftentimes they first become noticeable when a child hits a growth spurt between the ages of 12 and 14.

Symptoms of pectus excavatum or carinatum?

Some people with mild pectus conditions live with no negative physical symptoms. But people with moderate to severe cases may experience:

Pectus excavatum or sunken chest deformity on a teenage boy
Pectus excavatum, also called sunken chest, is a condition that pulls the breastbone inward. It affects 1 out of every 500 children.
  • Shortness of breath
  • Fatigue
  • Chest pain
  • Irregular heartbeat

Your child may first notice symptoms during gym class, while playing sports, or in everyday activities. In the past, they might have easily kept up with their peers, but now they’re getting fatigued and short of breath must sooner.

Chest wall conditions also can be associated with connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, and homocystinuria, a condition in which the body can’t break down a specific type of protein.

Pectus excavatum can affect a young person’s growth, too, causing the body to burn extra calories at rest due to cardiovascular inefficiency. It’s not uncommon to hear students with pectus conditions say, “I’ve been eating a ton to put on weight for football, but I can’t gain muscle.” One study found that the height, weight, and body mass index (BMI) of children with pectus excavatum were significantly lower than healthy peers. However, treatment allowed them to catch up.

If your child has symptoms, talk with a specialist in pediatric chest wall deformities about treatment options. Correcting a sunken or pigeon chest isn’t just a vanity thing; it can play a significant role in improving a young person’s self-esteem. We also can recommend counseling or support groups where they can talk with others facing similar challenges.

Surgery is typically performed during the rapid growth phase of puberty, but there are nonsurgical and surgical options available before and after puberty, even into adulthood

What are the nonsurgical treatments for pectus deformities?

Most children with pectus carinatum can be treated by wearing a circular brace that gently pushes on the breastbone and remolds the chest by applying measured, gentle pressure.

Dr. Adam Alder, pediatric surgeon
The Dynamic Compressor System is customized to fit each child and contains a device to measure the flexibility of the thoracic wall and regulate pressure of the brace. (Image courtesy of Pampamed SRL.)

UT Southwestern is one of the few centers in the country to offer the Dynamic Compressor System brace, which is customized to fit your child and has front compression plates anchored to bars that encircle the chest. The system contains a device to measure the flexibility of the thoracic wall and regulate the pressure of the brace. This allows us to more accurately dial in the pressure to make it comfortable yet effective.

Most patients will wear the brace for six months to a year, and it can be worn over a thin shirt and hidden under most clothing. Research shows that 85% of children who wear the brace as prescribed will achieve their desired chest shape.

Your doctor will recommend how long your child should wear the brace each day, but generally it’s recommended to wear it at least 10 hours a day. Kids often wear them at home at night and while sleeping, but we see some kids who wear it all day every day because they are especially motivated to change the way their chest looks. The more often the brace is worn, the more quickly change will occur.

Treatment for mild pectus excavatum can include exercises to improve posture and upper body strength. For children with mild to moderate pectus excavatum, vacuum bell therapy may be an option. This nonsurgical treatment uses a sort of suction cup to lift the sunken chest over time. Your child will need to use the vacuum bell between 30 minutes and two hours twice a day for up to a year, or possibly longer.

What are the surgical treatments for chest-wall deformities?

For the small percentage of pectus carinatum patients for whom bracing doesn’t work and for patients who have pectus excavatum, there are two main surgical options:

X-ray of chest wall deformity surgery
Surgery for chest wall deformities involves inserting a metal bar under the ribs to reshape the chest.
  • Nuss procedure: In this minimally invasive surgery for pectus excavatum, the surgeon will make three small incisions on your child’s chest. They will then insert under the ribs a metal bar that is shaped to your child’s chest and secure the bar under the sternum to lift the chest. The bar will remain in place for two to three years and is removed during outpatient surgery.
  • Ravitch procedure: Used for pectus carinatum and pectus excavatum, this surgery involves making an incision across the chest and removing abnormal rib cartilage to allow the breastbone to be pushed up or down to take a normal shape. An absorbable strut is placed in the chest to keep the breastbone in place until the cartilage regrows.

Our team has developed a new approach to minimize pain and reduce the need for pain medication following surgery. We use cryotherapy during the procedure to freeze the nerves that trigger pain sensation in affected areas of the chest wall. Where once these surgeries required a weeklong hospital stay and extended periods of opioid medication, patients now can return home a day or two later, and pain medication is tapered off within a few days.

Treatment for pectus excavatum or pectus carinatum can relieve pressure on the heart or lungs and improve breathing, exercise intolerance, and chest pain. While treatment won’t magically turn your child into an elite athlete, it can help them breathe better, gain more energy, and reach their full potential. It also can help your child feel better about their body and more confident at the swimming pool, in the locker room, or during everyday activities.

To talk with an expert about treatment for pectus excavatum or pectus carinatum, call 214-645-8300 or request an appointment online.

'We're going to take good care of you'

Adam Alder, M.D., is Director of the Center for Chest Wall Anomalies and Pectus. He specializes in pediatric and neonatal surgery at UT Southwestern and is passionate about establishing trust with his young patients and reassuring them about their treatment plan.