Understanding the deformity
In pectus excavatum, abnormal costal cartilage growth pulls the sternum inward. Presentation ranges from a mild cosmetic depression to a deep defect associated with exercise intolerance, chest pain and, in severe cases, cardiac compression. Assessment usually combines clinical examination with cross-sectional imaging and a severity index.
Because the deformity often becomes marked during adolescent growth, decisions about timing and technique are made jointly between the patient, family and surgical team.
Approaches to repair
Minimally invasive repair (the Nuss procedure / MIRPE) passes a curved bar behind the sternum through the pleural space to push the sternum forward, with the bar removed after remodelling. Open repair (Ravitch) resects abnormal cartilage and stabilises the sternum.
Extrapleural elevation instead lifts the sternum from the front, fixing it with a plate and support so the pleural cavity is not entered. Avoiding intrathoracic dissection is intended to reduce postoperative pain, remove the risk of cardiac injury during bar passage, and simplify the recovery pathway.
Chest wall stabilisation after repair
Rigid fixation of the sternum and ribs is central to chest wall surgery beyond pectus repair — including sternal closure, rib fracture fixation and reconstruction after resection. The same implant systems used for stabilisation in trauma and oncological resection are used to secure the corrected chest wall.
Common questions
What is pectus excavatum?
Pectus excavatum is a congenital chest wall deformity where the sternum is displaced backwards, creating a sunken appearance to the chest. Severe cases can be associated with exercise intolerance and cardiac compression.
How is pectus excavatum repaired?
Repair options include minimally invasive bar placement (Nuss/MIRPE), open cartilage resection (Ravitch), and extrapleural elevation techniques that lift and fix the sternum without entering the pleural cavity.