What is pectus excavatum

Pectus excavatum is a genetic deformity of the anterior thoracic wall. The breastbone and ribcage grow abnormally, resulting in a sunken chest appearance. If the condition is severe, it can look like the middle of the chest is scooped out, creating a deep hole.

The concave sternum can be visible after birth. In 90% of all cases, it is detected within the first year of life. However, the disorder worsens after the puberty growth spurt. That is a period where the posture in adolescences gets worse because of the rapid development of the body.

Even slight cases of pectus excavatum can make children insecure about their body appearance. The deformity mostly affects teenagers, leading to a decrease in self-confidence and social anxiety.

The adverse psychological effects caused by the concave chest condition make teenagers avoid doing any tasks that show their chest.

On top of that, pectus excavatum can cause heart and breathing function problems while running. This causes shortness of breath and sharp pain in the chest and back area.

Doctors don't know what causes pectus excavatum.

For now, you should know that pectus excavatum is treatable both surgically and non-surgically. Both methods are effective. It will be up to you to decide which path you are going to take.

In the text below, I will discuss the advantages and disadvantages of both methods.



Do You Have Pectus Excavatum?

There is an obvious way to determine whether you have pectus excavatum or not. However, the severity of the deformity is always different. That makes sufferers with a slight abnormality in the chest wondering whether they have it or not.

If your chest is dented slightly and you have some of the following symptoms, that is a clear sign that you suffer from pectus excavatum.

The main symptom for pectus excavatum is a sunken appearance of the breastbone. The depth of hollowness differs from person to person. It starts to get worse during puberty and continues to worsen during adulthood.

Another common symptom is a flare in the lower area of the ribs. Most doctors claim that protruding of the left rib is more common than the right rib counterpart. The rib flare deformity causes lack of equality in the diaphragm, which can lead to chest and heart pain.

Uneven chest musculature is also an excellent indicator for pectus excavatum.

concave chest

In minor cases of pectus excavatum, heart functioning is normal. Nevertheless, the condition can relocate or rotate the positioning of the heart.

This results in a rapid and irregular heartbeat. If the disorder is severe, there can be compression to the right atrium, mitral valve prolapse can occur, which leads to a reduction in physical abilities.

Most pectus excavatum sufferers experience ache in the chest and back area. The pain is usually present during the day, especially during any physical activity. This may lead to insomnia.

Pectus excavatum sufferers are prone to recurrent lung infections, painful coughing, or wheezing.

how common is pectus excavatum

How Common is Pectus Excavatum?

Pectus excavatum also known as an indented chest is more frequent in males than females.

The ratio is 3:1 in favor of males. It is projected to occur in about one person every 300-400 births.

The intended chest is the most common type of congenital chest wall deformity (90% of all chest structure deformities are diagnosed as pectus excavatum).

It is followed by pectus carinatum diagnoses (7% of all chest deformities). That is where the breastbone is pushed outward. It is also known as pigeon chest.


Is Pectus Excavatum Considered a Disease or Deformity

Pectus excavatum is not a disease. You can't get "infected" from pectus excavatum with coughing, touching, kissing or sneezing by someone who suffers from it.

It is a genetic structural deformity of the anterior thoracic chest wall. In most occasions, it is present at birth in newborns and progresses during puberty. 

Recent studies concluded that pectus excavatum might direct the existence of a hereditary illness of connective tissue such as the Marfan syndrome.

I've seen a lot of content online, mainly on Q&A sites, how people are categorizing pectus excavatum as a disease. Every single scientific article about pectus excavatum classifies it as deformity, not a disease.

Is pectus excavatum considered a disease or deformity

How to Fix Pectus Excavatum

Surgical repair

The first option is surgery. That is an elective procedure that usually requires insurance approval in the United States. The operation is generally done in the adolescent years when the person is in puberty.


That's the period where a massive growth spurt hits every kid and can worsen the intended chest deformity if left untreated.

Pectus excavatum surgery for adults is possible, but it isn't as effective as doing it in the teenage years. That is because the anterior chest wall of the adult patient is "stiffer" than the younger patients.

Adults are more prone to complications during and after the operation. Also, there is a high chance of recurrence of the malformation after the surgery.


There are two types of pectus excavatum surgery.


Ravitch operation

The first one is an open repair Ravitch procedure.


Surgeons make a horizontal cut along the middle of the patient's chest. The cut is done to remove the abnormal ribcage costal cartilages. The cartilage is lined to a healthy state, making the breastbone get in normal position.


If the pectus excavatum condition is severe, a break in the breastbone is made to help it get back in a front position. In addition to removing the abnormal cartilage and making the break, an impermanent bar is placed to keep the breastbone in the wanted area. 


The surgeon does the Ravitch procedure in about 6-8 hours on average.

how to fix pectus excavatum

NUSS PROCEDURE

The second one is the minimally invasive Nuss procedure.


The surgeon does this surgery by placing a metal pectus bar underneath the sternum. The bar is modified and cut precisely to fit each patient. The surgeon inserts it in the patient's body by making small cuts under each arm.


An endoscope is used to monitor the vital internal organs of the patient, especially the heart. That is done to prevent any cuts to them that can lead to excessive blood loss, which can be deadly.


The pectus bar goes over the ribcage and under the breastbone, pushing it to the required normal position. The surgeon secures its ends to the chest wall with screws.


The Nuss procedure takes on average about 4 hours to be done by surgeons. Every patient who underwent this procedure needs to carry the titanium bar underneath the sternum for 2-3 years.


Many physical activities need to be limited by the patient during this period. Recovery still requires a few weeks after pectus bar removal.


Both surgeries are done under general anesthesia and require a post-operation hospital stay of seven days. Most patients are good candidates for Nuss procedure. However, the choice of surgery is usually made by the surgeon, depending on the patient's dent severity and age.

Non-Surgical Treatment of Pectus Excavatum

Back in the days, the only way to correct pectus excavatum through a surgery. In the last few years, there's an increase in scientific evidence that proves the effectiveness of correcting the concave chest with non-surgical methods.


I had a severe case of funnel chest and flared ribs. I fixed them in a year by consistently performing a proven physical therapy routine, wearing posture braces, and using a vacuum bell.


If you combine these three, your pectus excavatum condition will see a significant correction in a year.

Pectus excavatum surgery for adults is possible, but it isn't as effective as doing it in the teenage years. That is because the anterior chest wall of the adult patient is "stiffer" than the younger patients.


Physical Therapy

Physical therapy consists of performing the most excellent pectus excavatum exercises and stretching the tight muscles that cause imbalances and worsen your posture. Performing deep breathing will also help you lift the sternum.

Pectus Excavatum Exercises

Yoga

Swimming

Deep Breathing


Wear Posture Braces

Wearing correct pectus excavatum braces, daily will have a positive impact on your caved in chest.

click here for scientific evidence of brace effectiveness

I wore the LaceIT pectus excavatum brace for about a year. It provided enough pressure on my abnormal chest bone structure to reshape it while being comfortable on my skin.

It is hands-down the most magnificent brace you can wear for treating the deformity.


I combined wearing that with physical therapy. My condition improved so much that my doctor was impressed by the effectiveness of the non-surgical method.

Click the following link to see a detailed review of the top 5 pectus excavatum braces you can purchase in 2019. Some of the most popular braces are the Neo G concave chest brace and LaceIT brace. I reviewed them based on comfort, external pressure, breathability, and adjustability.


These factors play a considerable role in the effectiveness of the brace in correcting pectus excavatum. I also wrote about the times when you should wear the brace, when you shouldn't, how long to wear it, before and after pictures and much more.


Vacuum Bell therapy

The vacuum bell is a rubber bell, or a cup designed device that links to a pump. When you put the device over the dent, the pump draws air out of the invention. A vacuum is made that pulls the chest and sternum back to the correct position. After a prolonged period of use, the chest will get back to correct positioning on its own.

The vacuum bell therapy is exceptionally safe in treating pectus excavatum without surgery. Over the years, there were just a few complication reports. The reports serve as additional proof about the safety.

how to use vacuum bell


Advantages of non-surgical therapy in correcting sunken chest

There are many advantages of choosing the non-surgical treatment for fixing concave chest, in comparison to surgical procedures.

Also, there is much less of a psychological toll on the patient. Pectus excavatum surgery can be taxing psychologically.

The thought of having a titanium bar underneath the sternum, for three long years can be devastating.

On top of that, the Ravitch procedure will leave a substantial horizontal scar across your chest. In some occasions, the scar will look far worse and will draw more attention than having a caved-in chest.

Lots of patients regretted undergoing a Nuss or Ravitch procedure. That isn't the case when you treat the condition non-surgically.

Give yourself a year. Try to do everything I tell you to do. Perform the greatest exercises for funnel chest, wear a brace, use vacuum bell, go swimming, perform deep breaths. I guarantee that in a year, you will be glad that you didn't take the surgery.

If the non-surgical way of correcting pectus excavatum fails, you can still take the surgery.

Another benefit of non-surgical treatment is that it is far cheaper. You don't need to pay thousands of dollars for surgery, hospital stay, and medications. The surgery cost for adults in the United States is very high, without insurance.

The only thing that separates success and failure is discipline. You need a lot of discipline if you choose to fix the deformity non-surgically. Stay dedicated to the daily schedule, and do everything that you're supposed to do, even when you don't feel like doing that.

Honestly, it only takes about 30-45 minutes in your day to do all the physical therapy exercises. Also, wear a brace throughout the day, and you'll be fine.


What Kind of Doctor Treats Pectus Excavatum?

Most people assume that pectus excavatum patients need to be treated by orthopedic surgeons. As you already know, this is a bone deformity condition. People who want to treat the condition non-surgically usually look for Orthopedic offices.

It is very logical to think that, but sometimes the Pediatric Orthopedics offices aren't familiar with pectus excavatum, because they don't treat it. That is the problem with the medical system in the United States. There is a piece of clear scientific evidence that proves pectus excavatum can be treated using Orthopedic principles.

They neglect that fact and want the pectus excavatum sufferers to be treated only by surgery. I honestly think that is done because the medical system cannot profit as much from non-surgical treatment for patients.

The people that treat pectus excavatum are called Upper Thoracic Specialist.

The Upper Thoracic surgeons usually treat patients that had a heart attack. However, the ribcage isn't just a set of bones. These surgeons are specialized to deal with any damage to the internal organs in the ribcage.

If the pectus excavatum condition is severe, it may press and damage the organs in that region.

The doctor you need to look for is the Upper Thoracic Surgeon. Even though the title is "surgeon," it doesn't mean that you'll need surgery. This surgeon treats both pectus excavatum and carinatum conditions.

what kind of doctor treats pectus excavatum

Does pectus excavatum get worse with age?

Pectus excavatum doesn't go away on its own. In most occasions, it even gets worse as you age.

Most of the time, it gets worse because of weak musculature, improper posture, and shallow breathing.

You must stop it from getting worse because it can press and dislocate the positioning of your heart and lungs. The pectus excavatum worsening, will lessen their working capacities, causing you respiratory infections and heart diseases.

The life expectancy of pectus excavatum sufferers is much shorter than people without it. There is a high possibility it will cause problems in the later life.

Pectus excavatum sufferers underestimate how many problems can be caused by this condition. If you remain still, the dent will get more in-depth, and your confidence will get shattered even more. That will make you an ideal candidate for surgery.

Waiting is a mistake that many pectus excavatum sufferers make. They aren't aware that pectus excavatum gets worse day by day. It is delusional to think that pectus excavatum goes away with time.

There is a scientific article that discusses how a healthy 59-year old male started having constant aches in the body, fatigue, breathing problems, and heart complications. This was all caused by not treating his pectus excavatum condition when he was younger.

After undergoing a Ravitch procedure, all these problems disappeared.

It is vitally important to change your lifestyle to be congruent around the pectus excavatum condition. You'll reap a lot of psychological and physical benefits if you opt to treat the malformation non-surgically.

does pectus excavatum get worse with age

How to Determine Severity of Pectus Excavatum

Determining the severity of pectus excavatum can be done with two methods. The Haller index is still the most used method; however, the Sternum Index method shows to be a great alternative to it.

Sternum Index

Radiologists can determine pectus excavatum severity with a revolutionary method called Sternum Index (SI). It is used to reduce radioactive exposure done by the Haller Index (HI) method, preoperatively.


The Sternum Index (SI) is calculated based on the anteroposterior diameter of the chest dent, from the breastbone to the spine, divided by the patient's height.

Sternum Index =

anterioposterior diameter of the chest hole / the sufferer’s height x 100

how to determine severity of pectus excavatum


Recent studies have compared the results received by the Sternum Index and Haller Index. 109 patients were a part of the study. After the studies, there was a minimal variation between the Haller Index and Sternum Index methods.


The studies showed that there was a good relationship between the HI and SI methods. The study concluded that the Sternum Index is a fantastic alternative to Haller Index in determining the severity of pectus excavatum, without any radiation exposure.

Pectus excavatum surgery for adults is possible, but it isn't as effective as doing it in the teenage years. That is because the anterior chest wall of the adult patient is "stiffer" than the younger patients.

Haller Index

The Haller index (HI), also known as pectus index, is the most commonly used method to determine the harshness of pectus excavatum. It is a mathematical method that evaluates and describes the chest wall structure on a CT scan of the thorax. HI is used for preoperative and postoperative estimation.

Haller Index =

distance of the inside ribs at the lower third of the breastbone / distance between the sternal notch and vertebral column

Recent scientific studies show that simple chest x-rays are just as useful as CT scans for calculating the Haller Index. Some radiologists started implementing CXR instead of CT scans. If the pectus excavatum deformity looks severe, then a standard CT scan is used.

Certain Haller Index values determine how severe the pectus excavatum is.

1.

Standard Chest < 2.0 HI

2.

Slight Pectus Excavatum < 2.0 - 3.2 HI

3.

Moderate (Mild) Pectoralis Excavatum < 3.2 - 3.5 HI

4.

Serious Pectus Excavatum > 3.5 HI

Surgeons must schedule pectus excavatum surgery if the Haller Index is equivalent to or higher than 3.3. If the HI is that high, it will cause respiratory and heart problems that cannot be treated with conservative non-surgical therapy.


However, Haller Index of 3.3 is very severe, and you probably have undergone surgery in your childhood to correct it.


Otherwise, non-surgical treatment is still the best solution for fixing pectus excavatum.

Pectus excavatum surgery for adults is possible, but it isn't as effective as doing it in the teenage years. That is because the anterior chest wall of the adult patient is "stiffer" than the younger patients.


How To Hide Pectus Excavatum

The unnatural look of the chest is the main reason why sufferers want to hide their pectus excavatum condition from the world.

I've seen people with far worse sunken deformity than others, accept their flaws, and even embrace their body appearance. They live more freely and also take off their shirts at the pool parties.

When I feel self-conscious, I always look up to the celebrities and athletes with pectus excavatum. They are the epitome of confidence because they decide to show their imperfect bodies to the whole world.

Even though they were insecure about it in the past, they decided to crush that fear and live freely after.

There is no reason for you to hide your pectus excavatum disorder. Every single person in the world is insecure about something in their appearance. Don't be surprised to know that some supermodels hate the way they look.

Victoria's Secret supermodel Miranda Kerr said that the models are some of the most insecure people in the globe.

Don't be harsh on yourself if you suffer from pectus excavatum. You're not the only person in the world who is insecure about how your body looks.

how to hide pectus excavatum

Hiding pectus excavatum is the easiest thing you can do. All you need to do is put a shirt on, never take it off at the beach and never turn on the lights during intimate moments.
However, that is not the healthiest way you can live life. The thought of having a major flaw will always be at the back of your mind.

When the thought of "How to hide my horrible dent in my chest" occupies your mind, there are two things to do; Embrace your uniqueness and start the non-surgical treatment.

The pectus excavatum condition will be less evident if you build the inner pectoralis muscles in the chest. Don't focus on that muscle only. Build the pectoralis muscles, add mass in your upper body, and improve your posture. That is how the pectus excavatum becomes much less noticeable.