Why does my chest look sunken? A Guide to Pectus Excavatum

October 2, 2025 •

4 min read

Affecting an estimated 1 in 400 individuals, pectus excavatum is a congenital chest wall deformity that can cause your chest to look sunken. This condition, also known as funnel chest, results from abnormal growth of the rib cartilages.

Quick Summary

The appearance of a sunken chest is typically caused by pectus excavatum, a congenital chest wall deformity where the sternum and attached rib cartilages grow abnormally inward. Its severity varies and often becomes more noticeable during adolescent growth spurts.

Key Points

Primary Cause: Pectus excavatum, a congenital deformity, is the most common reason for a sunken chest, caused by abnormal rib cartilage growth.
Symptoms Vary: While primarily cosmetic, severe cases can cause physical symptoms like shortness of breath and chest pain by compressing the heart and lungs.
Diagnosis is Crucial: Evaluation involves a physical exam and imaging like CT scans to measure severity using the Haller Index.
Treatment Options Exist: Non-surgical options include vacuum bell therapy and physical therapy, while surgical repairs like the Nuss or Ravitch procedures are available for more severe cases.
Psychological Impact is Significant: The visible deformity can severely affect self-esteem and body image, particularly during adolescence.
Correction is Possible: With various treatment methods, many individuals can achieve both cosmetic and functional improvement, enhancing their quality of life.

What is Pectus Excavatum?

Pectus excavatum is the most common congenital chest wall deformity, characterized by a caved-in or concave appearance of the sternum (breastbone) and ribcage. The term, derived from Latin, means 'hollowed chest'. This condition occurs when the cartilage that connects the ribs to the breastbone grows excessively, pushing the sternum inward. While often present from birth, it frequently becomes more pronounced during adolescent growth spurts. It is three to five times more common in males than in females.

The severity of pectus excavatum can range from mild, presenting primarily as a cosmetic concern, to severe, where the indentation may compress the heart and lungs, causing physical symptoms. While the exact cause remains unknown, a combination of genetic and developmental factors is suspected.

Potential Causes of a Sunken Chest

While the exact cause is unclear, several factors and associated conditions are linked to the development of pectus excavatum. These include:

Genetic Factors: Pectus excavatum can run in families, suggesting a hereditary component. Some studies show that up to 25% of affected individuals have a family member with a chest wall abnormality.
Connective Tissue Disorders: The condition is sometimes associated with more complex genetic syndromes affecting connective tissues, such as Marfan syndrome, Ehlers-Danlos syndrome, and Poland syndrome.
Uncoordinated Growth: The deformity may result from uncoordinated growth between the costal cartilage (rib cartilage) and the rest of the ribcage. When the cartilage grows faster than the surrounding structures, it can push the sternum inward.

Symptoms and Impact on the Body

The most obvious symptom of pectus excavatum is the visual indentation of the chest. However, the condition can also lead to other physical and psychological effects. Symptoms often worsen during puberty and may progress with age.

Common Physical Symptoms include:

Cardiopulmonary Issues: In severe cases, the sunken breastbone can compress the heart and lungs, leading to symptoms like shortness of breath, chest pain, and a rapid or irregular heartbeat, especially during exercise.
Decreased Exercise Tolerance: Due to the potential restriction on heart and lung function, individuals may experience fatigue and decreased stamina during physical activity.
Poor Posture: Many people with pectus excavatum develop a stooped posture with rounded shoulders, which can make the sunken appearance more noticeable.
Chest Pain: Some patients report experiencing pain in the chest area, which is sometimes attributed to musculoskeletal strain.
Frequent Respiratory Infections: Lung compression can lead to an increased risk of respiratory illnesses.

Psychological and Emotional Impact:

Self-Consciousness: The cosmetic appearance can cause significant psychological distress, leading to self-consciousness, low self-esteem, and social withdrawal, particularly in adolescents.

Diagnosis and Evaluation

A healthcare provider can usually diagnose pectus excavatum with a physical examination. To determine the severity and potential impact on heart and lung function, further testing may be recommended. These diagnostic steps can include:

Medical History and Physical Exam: The doctor will ask about symptoms and family history and visually assess the chest.
Imaging Scans: A CT scan or MRI is often used to get a precise look at the chest structure. A critical measurement taken from a CT scan is the Haller Index, which measures the ratio of the chest's width to its depth. A higher index indicates a more severe case.
Heart and Lung Function Tests: These may include pulmonary function tests (PFTs) to measure lung capacity and an echocardiogram (ECG) or cardiac stress test to evaluate heart function.

Comparison: Pectus Excavatum vs. Pectus Carinatum


Feature	Pectus Excavatum	Pectus Carinatum
Appearance	Sunken or caved-in chest (funnel chest)	Protruding or pushed-out chest (pigeon chest)
Cause	Abnormal inward growth of the sternum and rib cartilage.	Abnormal outward growth of the sternum and rib cartilage.
Physical Impact	Can compress heart and lungs in severe cases, causing symptoms like fatigue and shortness of breath.	Typically less likely to cause heart/lung issues, but can sometimes result in shortness of breath during exertion.
Psychological Impact	Can cause significant distress due to visible indentation.	Can cause self-consciousness due to visible protrusion.
Treatment Options	Vacuum bell therapy, Nuss procedure (minimally invasive surgery), Ravitch procedure (open surgery), implants.	Bracing, Ravitch procedure (for severe cases).

Treatment Options for a Sunken Chest

Treatment for pectus excavatum is based on the condition's severity and the presence of symptoms. Mild, asymptomatic cases may not require treatment, while more severe cases may benefit from intervention.

Non-Surgical Treatments

Vacuum Bell Therapy: A non-invasive method using a suction cup device placed on the chest to gradually lift the sternum outward. This is most effective for younger patients with more flexible chest walls and mild to moderate deformities.
Physical Therapy and Exercises: Strengthening exercises and deep breathing techniques can help improve posture and increase chest expansion. While exercise cannot fix the underlying bone structure, building muscle mass in the chest and back can improve appearance and function.

Surgical Treatments

For more severe cases, surgery may be the best option to correct the deformity and relieve pressure on internal organs.

The Nuss Procedure: A minimally invasive surgical technique where a curved metal bar is inserted under the sternum to push it into a normal position. The bar remains in place for several years before being removed in a later, simpler procedure.
The Ravitch Technique: A more traditional open surgery that involves a larger incision to remove the abnormally grown cartilage. The sternum is then repositioned and held in place with metal struts or mesh supports.

Conclusion: A Path Forward

Discovering you have a sunken chest can be a distressing experience, but it's important to remember that it's a common and treatable condition. With proper diagnosis, you can understand the severity of your specific case and explore the best course of action. For many, non-surgical options offer significant improvement, while others benefit from surgical repair. Regardless of the path, seeking a professional medical evaluation is the critical first step toward improving both your physical health and self-confidence.

For more information on chest wall deformities and available treatment options, you may consult with a specialist at an institution like the Children's Hospital of Philadelphia.

Frequently Asked Questions

In most mild cases, a sunken chest is not dangerous and does not affect internal organ function. However, in moderate to severe cases, the deformity can compress the heart and lungs, which can lead to symptoms like reduced exercise tolerance, shortness of breath, and chest pain.

The exact cause is unknown, but it is believed to be linked to abnormal, excessive growth of the rib cartilages. Genetic factors may play a role, as the condition sometimes runs in families or is associated with certain connective tissue disorders.

Exercise cannot correct the underlying skeletal deformity, but physical therapy and specific exercises can strengthen the chest and back muscles, improve posture, and increase chest expansion. This can sometimes improve the cosmetic appearance and alleviate some physical symptoms.

Yes, while surgery is often performed during adolescence, adults can also undergo surgical correction. The Nuss and Ravitch procedures can be used in adults to improve symptoms and appearance, often with excellent results.

Besides the visible indentation, symptoms can include decreased exercise stamina, fatigue, chest pain, and postural issues like rounded shoulders. In severe cases, heart palpitations and shortness of breath can occur.

There is evidence of a genetic link, as pectus excavatum is known to run in families. While not every case has a family history, the occurrence in multiple family members suggests a hereditary component.

Pectus excavatum is a caved-in or sunken chest, while pectus carinatum is the opposite, featuring a protruding or pushed-out chest. Pectus excavatum is more common and often has more potential to cause internal organ compression.

The deformity often becomes more noticeable during the rapid growth of puberty and can continue to worsen into young adulthood. While the progression may stop, symptoms associated with heart and lung compression can become more pronounced over time.