Treatments and drugs

By Mayo Clinic Staff

Pectus excavatum can be surgically repaired, but surgery is usually reserved for people who have moderate to severe signs and symptoms. People who have mild signs and symptoms may be helped by physical therapy. Certain exercises can improve posture and increase the degree to which the chest can expand.

If you have mild pectus excavatum, your doctor may want to re-evaluate you every six to 24 months, to make sure your symptoms haven't worsened.

Types of surgery

If you have moderate to severe pectus excavatum, your doctor may suggest surgery. The two most common types of surgeries used to correct pectus excavatum differ by the size of the incisions used:

  • Larger incision. The larger, center-of-the-chest incision used in the Ravitch technique allows the surgeon to view the breastbone directly. The abnormal cartilage attaching the ribs to the lower breastbone is removed and the breastbone is fixed into a more normal position with surgical hardware, such as a metal strut or mesh supports. These supports are removed in nine to 12 months.
  • Smaller incisions. In the minimally invasive Nuss procedure, small incisions are placed on each side of the chest, under each arm. Long-handled tools and a narrow fiber-optic camera are inserted through the incisions. A curved metal bar is threaded under the depressed breastbone, to raise it into a more normal position. In some cases, more than one bar is used. The bars are removed after two years.

Comparable risks and outcomes

Both the Ravitch and Nuss procedures have been revised and improved over the years. While the Ravitch technique takes longer to complete, the Nuss procedure typically results in a longer hospital stay. Success rates are higher at hospitals that perform more of these types of surgeries.

Most people who undergo surgery to correct pectus excavatum are happy with the change in how their chests look, no matter which procedure is used. Either procedure also improves heart function. Best results are achieved when the surgery is performed after the age of 8 and before the end of adolescence, but adults also have benefitted from these types of surgeries.

Apr. 15, 2011