Pectus Excavatum: Why Your Sternum Is Dipping & Medical Next Steps

If you've noticed that your chest looks sunken in the center, you may be dealing with pectus excavatum. This condition, sometimes called "funnel chest," happens when the breastbone (sternum) sinks inward. For some people, it's mostly cosmetic. For others, it can affect breathing, exercise tolerance, or heart function.

Here's what you need to know about pectus excavatum, why it happens, and what medical steps to consider next.

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What Is Pectus Excavatum?

Pectus excavatum is a structural chest wall condition where the sternum and attached ribs grow abnormally inward. It's the most common congenital chest wall deformity.

Key facts:

• It affects about 1 in 300–400 births.
• It is more common in males than females.
• It often becomes more noticeable during growth spurts in adolescence.
• It can range from mild to severe.

In mild cases, it may cause no medical problems. In more severe cases, the inward chest shape can compress the lungs and heart.

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Why Is Your Sternum Dipping?

The exact cause of pectus excavatum isn't fully understood, but research shows it likely involves abnormal growth of the cartilage that connects the ribs to the sternum.

Instead of growing evenly outward, the cartilage overgrows and pushes the sternum inward.

Risk Factors and Associations

Pectus excavatum can occur on its own, but it is sometimes associated with:

• Family history (it can run in families)
• Marfan syndrome
• Ehlers-Danlos syndrome
• Scoliosis
• Other connective tissue disorders

If you have long limbs, flexible joints, or spinal curvature along with a sunken chest, your doctor may evaluate for underlying connective tissue conditions.

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Symptoms of Pectus Excavatum

Some people with pectus excavatum have no symptoms. Others may experience:

• Shortness of breath during exercise
• Reduced stamina
• Chest pain
• Rapid heartbeat
• Frequent respiratory infections
• Fatigue
• Poor posture

In more severe cases, the heart may be slightly compressed or shifted. This can affect how efficiently it pumps blood during physical activity.

It's important not to ignore persistent symptoms. While many cases are mild, moderate to severe pectus excavatum can have measurable effects on heart and lung function.

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Is It Just Cosmetic — or Medical?

This is one of the most common questions.

For many individuals, pectus excavatum is primarily a cosmetic concern. However, the severity matters.

Doctors often measure severity using imaging tests such as a CT scan. They calculate something called the Haller Index, which compares the width of the chest to the depth of the depression.

• A normal chest has a Haller Index of about 2.5.
• A measurement above 3.25 is generally considered severe.

If the depression is deep enough, it may:

• Reduce lung capacity
• Limit oxygen intake during exertion
• Compress the right side of the heart
• Affect posture and spinal alignment

That's why proper evaluation is important.

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When to See a Doctor

You should speak to a doctor if you notice:

• Worsening shortness of breath
• Chest pain
• Exercise intolerance
• Heart palpitations
• Significant body image distress
• Rapid progression during adolescence

Children and teenagers experiencing a growth spurt should be monitored, as pectus excavatum can worsen quickly during this time.

If symptoms feel severe, sudden, or life-threatening (such as crushing chest pain or difficulty breathing), seek urgent medical care.

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How Doctors Evaluate Pectus Excavatum

A medical evaluation may include:

Physical Examination

Your doctor will assess:

• Chest depth and symmetry
• Posture
• Spinal alignment
• Flexibility and connective tissue features

Imaging Tests

• Chest X-ray
• CT scan (to calculate Haller Index)
• MRI (in some cases)

Heart and Lung Testing

• Echocardiogram (heart ultrasound)
• Pulmonary function tests
• Exercise stress testing

These tests help determine whether pectus excavatum is affecting your cardiopulmonary function.

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Treatment Options for Pectus Excavatum

Treatment depends on severity, symptoms, and age.

1. Observation (Mild Cases)

If symptoms are minimal:

• Regular monitoring
• Posture improvement
• Physical therapy
• Breathing exercises

Strengthening back and chest muscles can improve appearance slightly and enhance lung expansion.

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2. Vacuum Bell Therapy

This non-surgical treatment uses a suction device placed on the chest to gently pull the sternum outward over time.

• Most effective in younger patients
• Requires consistent use
• Works best in mild to moderate cases

Results vary and require commitment.

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3. Surgical Correction

For moderate to severe pectus excavatum, surgery may be recommended.

Nuss Procedure (Minimally Invasive)

• A curved metal bar is inserted under the sternum.
• The bar pushes the chest outward.
• The bar remains in place for 2–3 years.
• Common in adolescents.

Ravitch Procedure

• Open surgery.
• Removes abnormal cartilage.
• Repositions the sternum.
• Less commonly used now but still effective.

Surgery is generally considered when:

• Haller Index > 3.25
• Significant symptoms
• Documented heart or lung compression
• Major psychosocial distress

Surgical outcomes are typically good when performed by experienced surgeons, but all surgery carries risks. Recovery takes time and requires careful follow-up.

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Emotional and Psychological Impact

It's important not to dismiss the mental health effects of pectus excavatum.

Teens and adults may struggle with:

• Body image concerns
• Social withdrawal
• Avoidance of swimming or sports
• Reduced self-confidence

These concerns are valid. If emotional distress is significant, it should be discussed with a doctor.

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Could It Be Something Else?

Not all chest wall pain or chest changes are caused by pectus excavatum.

If you're experiencing chest pain, it could be related to inflammation of the chest wall cartilage—a condition called Costochondritis. This type of pain can feel alarming but is usually not dangerous, and a free online symptom checker can help you understand if your symptoms align with this common condition.

However, online tools are not a substitute for medical evaluation.

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Can Exercise Fix Pectus Excavatum?

Exercise cannot "cure" pectus excavatum, because it is a structural issue involving bone and cartilage.

However, exercise can:

• Improve posture
• Increase chest expansion
• Strengthen back muscles
• Improve breathing efficiency
• Enhance appearance

Recommended types of exercise:

• Postural strengthening
• Core training
• Swimming
• Deep breathing exercises
• Yoga or Pilates

Always speak to a healthcare professional before beginning a new exercise program if you have significant symptoms.

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Long-Term Outlook

The long-term outlook for people with pectus excavatum is generally good.

• Mild cases often require no intervention.
• Moderate cases can be monitored safely.
• Severe cases can be effectively treated with surgery.

Most people live full, active lives — especially when symptoms are addressed early.

The key is proper evaluation rather than ignoring the condition.

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When to Take Immediate Action

Seek urgent medical care if you experience:

• Sudden severe chest pain
• Difficulty breathing
• Fainting
• Rapid or irregular heartbeat

While pectus excavatum itself is usually not life-threatening, chest symptoms should always be taken seriously.

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Final Thoughts: What Should You Do Next?

If your sternum appears to be dipping inward, the most important next step is a proper medical evaluation.

You should:

• Schedule an appointment with a primary care doctor or pediatrician
• Ask about imaging if symptoms are present
• Discuss heart and lung testing if exercise intolerance exists
• Consider referral to a thoracic surgeon if moderate to severe

Do not self-diagnose or ignore symptoms.

If anything feels serious, worsening, or life-threatening, speak to a doctor immediately.

Pectus excavatum can range from mild and cosmetic to medically significant. The good news is that effective evaluation and treatment options are available. The earlier you understand your condition, the better your outcomes are likely to be.