Pectus excavatum is a deformity of the chest in which the chest looks sunken or caved in. It occurs when the cartilage that holds the ribs to the breastbone e has a defect and pushes the breastbone inward, leaving a deep dent in the centre of the chest between the pectoralis major muscles.

The cause of this chest deformity is unknown however it is more common among those with Down’s syndrome, Edwards syndrome, connective tissue disorders such as Marfan syndrome and those with homocystinuria or morquio.Pectus excavatum may be mild, moderate or severe and depending on each individual case, surgical repair may or may not be needed. For those who have more severe pectus excavatum the breastbone puts pressure on the heart and lungs, and the sunken chest creates issues with self-esteem and confidence, surgery may be needed to relieve the pressure and correct the deformity.

What are the symptoms or signs of pectus excavatum?

While the condition is categorised by a deep indent in the chest, children with pectus excavatum often won't show any signs or symptoms until early adolescence when the conditions worsen due to the growth spurt at that age.

In the early teen years, mild to moderate cases may cause symptoms such as a small dent in the chest, shortness of breath during exercise or trouble breathing with various activities like playing the flute or singing. Late when rapid bone growth occurs in the early teenage years, the symptoms may become worse.

Symptoms of more severe cases of pectus excavatum include:

  • 1. Difficulty breathing which interferes with exercise
  • 2. Limitations with physical activities
  • 3. Tiredness
  • 4. Chest pain
  • 5. A rapid heartbeat or heart palpitations
  • 6. Frequent respiratory infections
  • 7. Coughing or wheezing, often diagnosed as asthma

These symptoms are caused by the pressure of the indentation on the lungs and heart and may require surgery not only to relieve the strain on these organs but to restore you or your child's quality of life and boost self-esteem.

While the signs are usually apparent in the teen years, for younger children with mild cases the diagnosis may be confirmed using a CT scan of the chest, lung function test and ultrasound of the heart. Dr Schewitz may be able to tell if the condition will cause self-esteem or health problems in the future and whether a repair may be needed.

While the best results for surgery are achieved when it is performed around the growth spurt that occurs at puberty, adults also have benefitted from pectus excavatum repair.Dr Ivan Schewitz has extensive experience in the treatment of children and adults with pectus excavatum. Taking the time to explain your condition and the possible surgical treatment options with you, Dr Schewitz is a compassionate cardiothoracic surgeon specialised in pectus deformity correction.

He may advise either the Nuss or Ravitch procedure for correction of pectus excavatum:

Nuss procedure
The Nuss procedure is a minimally invasive technique in which a long, stainless-steel bar is bent to the shape of the chest and inserted under the breastbone. This bar is then left in place. The bar is removed after three years. This pectus surgery is preferred for children.

View Nuss Procedure

Ravitch procedure
During the Ravitch procedure which is used rather seldom, Dr Schewitz will remove the abnormal or defected cartilage and ribs and move the breastbone into its correct position. To do this, the breastbone may need to be fractured. Once in the correct position, a short steel bar is placed behind the breastbone for roughly 6 months to keep it in place while the bone heals and the cartilage regrows and reconnects to the ribs. This procedure is seldom performed today. It has very special indications.

View Ravitch procedure