Pectus Excavatum & the Nuss Procedure

What is pectus excavatum?

Pectus excavatum, sometimes called a sunken or funnel chest, is a chest-wall difference in which the breastbone (sternum) sits farther inward than usual. It often becomes more noticeable during the teenage growth spurt. The exact cause is not fully understood, and it can run in families.

Many people have few or no physical symptoms. Others notice:

• Shortness of breath or tiring more easily during exercise.
• Discomfort at the front of the chest.
• Changes in posture or an increasingly visible chest indentation.

More pronounced cases can affect the space available for the heart and lungs. Pectus can also occur with scoliosis or a connective-tissue condition, although most patients do not have an associated disorder. ^[1]

How is pectus excavatum evaluated?

An assessment begins with your symptoms, medical history and a chest examination. Testing is tailored to the questions that need answering; not everyone needs every test.

• CT or MRI: shows chest shape and whether the heart or lungs are compressed.
• Heart testing: an ECG checks electrical activity; an echocardiogram examines heart structure and function.
• Breathing and exercise testing: lung-function tests and, when appropriate, exercise testing help assess limitations during activity. ^[3]

You may hear about the Haller index or correction index—measurements used to describe the depth of the indentation. Higher values generally indicate a more pronounced deformity. ^[4] The decision about treatment brings those measurements together with symptoms, functional effects and your goals. ^[2]

Does everyone need surgery?

No. The right approach depends on how pectus affects your health and daily life. Discuss the expected benefit, recovery commitment and alternatives before deciding. ^[2]

Understanding the operation

What is the Nuss procedure?

The Nuss procedure is also called minimally invasive repair of pectus excavatum (MIRPE). Small incisions are used, but it remains a significant operation that requires planning and recovery. ^[2]

1. During surgery. Under general anesthesia, the surgeon uses a small camera and incisions at the sides of the chest to position one or more curved metal bars behind the breastbone. The bars lift and support the chest in its new position. ^[6]
2. While the chest remodels. The bars are secured and remain inside the chest for several years, commonly around three. Follow-up continues during this period.
3. Planned bar removal. A separate operation removes the bars when the surgeon considers the chest ready. Removal is commonly a same-day procedure; timing is individualized. ^[7]

Can adults have the Nuss procedure?

Yes—selected adults can be candidates. An individualized assessment determines whether repair is appropriate and which approach fits the chest anatomy and treatment goals. ^[6] Choose a surgeon with specific experience in pectus repair. ^[4]

Mention metal allergies before surgery. A history of reactions to jewelry or belt buckles may affect allergy testing and the choice of implant material. ^[7]

Recovery and pain control

In the hospital: discharge depends on pain control, walking safely and eating and drinking adequately. Hospital stays vary with the patient and pain protocol; your team will explain the plan. ^[7]

Managing discomfort: several types of pain treatment may be combined. Some centers use cryoablation—temporary freezing of chest-wall nerves—to help control postoperative pain. Ask which options your surgical team offers. ^[6]

Returning to activity: early walking is encouraged, followed by a gradual increase in activity. Restrictions on lifting, twisting and sports protect the repair. Follow your own team's instructions. ^[7] Expect recovery to unfold over weeks to months; full recovery can take around six months. ^[6]

Potential benefits and risks

Repair can improve chest shape and self-image, and some patients experience better physical capacity. ^[4] Benefits must be weighed against the risks and burden of treatment; improvement is not guaranteed. ^[2]

Risks to discuss include:

• Bleeding, infection and postoperative pain. ^[6]
• Air around the lung (pneumothorax), persistent discomfort, numbness or nerve injury.
• Metal sensitivity, bar movement or implant problems that may require another operation.
• Incomplete correction or recurrence after treatment.
• Serious injury to the heart, lungs or surrounding structures; permanent injury or death is possible. ^[8]

Ask your surgeon about their experience, your individual risks and how complications are managed.