Why have I got a hole in my chest? Understanding Pectus Excavatum

September 27, 2025 •

3 min read

Pectus excavatum, also known as 'funnel chest,' is the most common congenital chest wall deformity, affecting approximately 1 in 400 births and causing the breastbone to sink inward. For many people asking 'Why have I got a hole in my chest?', the answer lies in this condition, which can range from a mild cosmetic concern to a source of significant physical symptoms.

Quick Summary

This chest wall deformity, where the breastbone grows inward, is known as pectus excavatum. Its cause isn't always clear, but it's often present from birth and may become more pronounced during growth spurts, potentially affecting heart and lung function in more severe cases.

Key Points

Pectus Excavatum is the medical term: The 'hole' in your chest is a condition where the breastbone and ribs grow inward, commonly known as funnel chest.
Cause is often unknown, but genetic links exist: While the exact cause isn't certain, it can be hereditary and is sometimes linked to connective tissue disorders.
Severity varies and can affect heart/lungs: Cases can range from mild and cosmetic to severe, where the indentation can compress the heart and lungs, impacting function.
Diagnosis involves imaging tests: Doctors use physical exams, CT scans, and other tests to determine the condition's severity and its impact on internal organs.
Treatment options include surgical and non-surgical approaches: Depending on severity, options range from physical therapy and vacuum bells for less severe cases to surgical repair (Nuss or Ravitch procedures) for moderate-to-severe ones.
Treatment can improve quality of life: Correcting the condition can alleviate physical symptoms like shortness of breath and chest pain, and also improve self-esteem and body image.

What is Pectus Excavatum?

Pectus excavatum is a structural deformity where the breastbone (sternum) and some ribs grow inward, creating a sunken appearance in the chest. Also called 'funnel chest,' this congenital condition is often more noticeable during adolescent growth spurts. It is the most common chest wall deformity.

The Anatomy of the Chest Wall

The chest wall includes the sternum, ribs, and costal cartilages that connect them. In pectus excavatum, the costal cartilages grow abnormally, pushing the sternum inward.

The Causes and Risk Factors

The exact cause is unclear, but genetics and environment likely play a role. A family history of the condition increases risk. It is also associated with connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome, and genetic conditions such as Noonan syndrome. Pectus excavatum is more common in males.

Signs and Symptoms of Pectus Excavatum

Symptoms can be physical or psychological and vary in severity. Physical symptoms can include shortness of breath, fatigue, chest pain, and rapid heartbeat. The cosmetic appearance can also lead to psychological effects like negative body image and social anxiety.

Diagnosis of Pectus Excavatum

A physical exam can identify the deformity. Further tests, such as a CT scan, are used to assess the severity and impact on internal organs. The Haller index, calculated from a CT scan, is a common measure of severity. An index greater than 3.25 is typically considered severe. Other tests like an echocardiogram, pulmonary function tests, and exercise stress testing may also be used.

Treatment Options for Pectus Excavatum

Treatment options depend on the severity and symptoms of the condition. Options range from observation in mild cases to surgical interventions for more significant deformities.

Comparison of Treatment Options


Treatment Method	Description	Ideal For	Outcome	Recovery	Pain
Observation	Monitoring without active treatment.	Mild cases with minimal symptoms.	No change in chest shape.	None.	None related to treatment.
Vacuum Bell	Non-surgical device using suction to lift the sternum.	Younger patients with flexible chest walls.	Gradual correction with consistent use.	Non-invasive, requires commitment.	Mild discomfort or bruising.
Nuss Procedure	Minimally invasive surgery inserting a bar to push the sternum out.	Moderate to severe cases, typically ages 10–14, but also adults.	Long-term correction.	Hospital stay, recovery period, bar removal.	Managed with pain control, including cryoablation.
Ravitch Procedure	Open surgery removing deformed cartilage to reshape the chest.	Asymmetrical cases or adults with calcified cartilage.	Effective, but more invasive.	Longer hospital stay and recovery.	Greater post-operative pain.
Physical Therapy	Exercises for posture and muscle strengthening.	Mild cases, and as a supplement.	May lessen appearance, improve posture.	Non-invasive, requires commitment.	None.
Implants	Cosmetic silicone implant to fill indentation.	Primarily cosmetic, without functional issues.	Aesthetic improvement.	Surgical recovery, less invasive than major repair.	Minimal.

Choosing a Treatment Path

Discuss treatment options with a healthcare provider, preferably a thoracic surgeon. Factors such as age, the severity of the condition, and its impact on your well-being are considered. While mild cases might benefit from physical activity and therapy, moderate to severe cases, particularly those affecting heart or lung function, may require surgery.

What to Expect from Treatment

Modern surgical techniques, such as the Nuss procedure, are often less invasive and can result in quicker recovery periods. Post-operative pain management has improved, sometimes including cryoablation. A hospital stay of a few days is typical, followed by recovery at home. If a supportive bar is used in surgery, it is usually removed after 2–3 years. Treatment can lead to improvements in heart and lung function, as well as self-esteem and body confidence.

Conclusion: Seeking Medical Advice

If you have a chest indentation and are asking 'Why have I got a hole in my chest?', it is important to see a doctor for a proper diagnosis and guidance. Even mild cases should be evaluated. A medical professional can assess the severity and recommend appropriate treatment to address both the physical and psychological aspects of the condition. For further information, consider consulting resources such as the {Link: Cleveland Clinic's guide https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum} on pectus excavatum.

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Frequently Asked Questions

The medical term for having a sunken chest is Pectus Excavatum, also known as funnel chest. It is a congenital deformity of the chest wall where the breastbone and several ribs grow inward.

For most people with mild cases, it is not dangerous. However, in moderate to severe cases, the inward growth can compress the heart and lungs, potentially causing health issues like shortness of breath, fatigue, and heart palpitations.

Yes, non-surgical options are available, particularly for milder cases or younger patients. Treatments include physical therapy to improve posture and a vacuum bell device, which uses suction to lift the sternum over time.

The condition often becomes more noticeable during adolescent growth spurts. While the physical deformity typically stabilizes after late adolescence, some symptoms might progress with age, even in mild cases.

The severity is often measured using a CT scan to calculate the Haller Index, which is the ratio of the chest's width to its depth. A higher index indicates a more severe deformity.

A strong genetic link is suspected, as studies show a high percentage of individuals with pectus excavatum have a family member with the same condition. It can also be associated with other genetic and connective tissue disorders.

You should start with your primary care physician, who can then refer you to a specialist such as a thoracic surgeon, cardiologist, or pulmonologist. A thoracic surgeon specializes in surgical repair of chest wall deformities.