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Health condition · Clinically reviewed

Chest wall deformities, from vacuum bell and bracing to Nuss and Ravitch surgery.

Pectus excavatum, pectus carinatum, Poland syndrome and rarer variants. Modern UK practice combines careful assessment, non-operative options and specialist surgery.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered clinician with a thoracic interest before publication.

  • 02

    Specialist-service framed

    Aligned to UK specialist chest wall services and current thoracic surgical practice.

  • 03

    Current for 2026

    Reflects modern non-operative options (vacuum bell, dynamic bracing) and Nuss and Ravitch surgical care.

Key facts

Chest wall deformities at a glance.

The essentials in plain English: the main types, how UK teams assess them and the ladder of treatment from vacuum bell to surgery.

  • Pectus excavatum

    Funnel chest, the most common deformity at roughly 1 in 400 births. Sternum and costal cartilages pushed inward, boys affected 4:1.

  • Pectus carinatum

    Pigeon chest, a less common protrusion of the sternum and cartilages at roughly 1 in 1,500, most obvious in adolescent boys.

  • Poland syndrome

    Congenital absence of pectoralis major with hypoplastic breast, syndactyly and sometimes absent ribs on one side.

  • Haller index

    A ratio measured on chest CT. Values above 3.25 suggest a significant excavatum deformity worth specialist review.

  • Non-operative first

    Vacuum bell for excavatum and dynamic bracing for carinatum can produce real correction in growing adolescents.

  • Nuss and Ravitch

    The two main surgical options. Nuss is a minimally invasive bar for excavatum, Ravitch is an open cartilage-and-sternal repair.

Why this guide matters

More than cosmetic, and often very treatable.

Chest wall deformities can affect heart and lung function, exercise capacity and self-image. The three points below shape everything else on this page.

  • Non-operative options first

    Vacuum bells and dynamic braces give many adolescents a real chance of correction without surgery, if started early.

  • Surgery is safe and effective

    Nuss and modified Ravitch procedures in specialist UK centres have excellent outcomes for both function and appearance.

  • It is a team decision

    Thoracic surgeons, cardiologists, respiratory doctors, physios and psychologists all have a voice in the plan.

How the diagnosis is made

From first look to a specialist plan.

The steps a UK GP and chest wall MDT will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Structured examination

    Depth, symmetry, sternal tilt and shoulder posture, plus a look for Marfan, Ehlers-Danlos or Noonan features.

  2. 02

    Assessing

    CT chest with indices

    A low-dose CT gives the Haller index and Correction index and shows cardiac and pulmonary compression.

  3. 03

    Assessing

    MRI in selected cases

    A radiation-free alternative for younger adolescents when serial imaging is likely.

  4. 04

    Confirming

    Lung function testing

    Spirometry with DLCO to look for a restrictive pattern and reduced gas transfer.

  5. 05

    Confirming

    ECG and echocardiogram

    Right-heart compression, mitral valve prolapse and arrhythmia are all screened for before surgery.

  6. 06

    Planning

    CPET and genetics as needed

    Cardiopulmonary exercise testing quantifies exercise limitation. Genetics is offered when a syndrome is suspected.

  7. 07

    Planning

    MDT at a specialist centre

    Thoracic surgery, cardiology, respiratory, physio and psychology plan care together at a UK chest wall service.

Typical timeline: first assessment to an MDT plan within a few months.

Symptoms

What chest wall deformities feel and look like.

Appearance is only part of the story. Breathlessness, palpitations and body-image distress often matter more to the person in front of you.

  • Sunken chest (excavatum)

    A midline depression of the sternum and costal cartilages, often deeper on the right and more obvious after puberty.

  • Protruding chest (carinatum)

    An outward bowing of the sternum, sometimes asymmetric, most noticeable in tall adolescent boys.

  • Reduced exercise tolerance

    Breathlessness on exertion out of proportion to fitness, often the first symptomatic complaint.

  • Palpitations and arrhythmia

    Cardiac compression can produce awareness of the heartbeat and, less often, documented rhythm disturbance.

  • Recurrent chest infections

    A restrictive pattern on spirometry with reduced FVC can lead to more frequent lower respiratory infections in some patients.

  • Poland syndrome pattern

    Unilateral absence of pectoralis major with a small or absent breast and, sometimes, hand differences on the same side.

  • Body image and mood

    Body-image distress, social withdrawal, low mood and anxiety are common and part of the reason to treat.

  • Red flag, syndromic features

    Tall stature, long limbs, joint hypermobility or lens dislocation should prompt Marfan and Ehlers-Danlos assessment.

Treatment

How chest wall deformities are treated in the UK.

A stepped ladder from observation to non-operative devices to modern minimally invasive and open surgery in specialist centres.

  • Observation

    For mild, asymptomatic deformities where the young person is not distressed. Serial review during growth is enough.

  • Vacuum bell (Klobe)

    A suction cup used daily for one to three years in pectus excavatum. Best results in flexible chests during adolescence.

  • Dynamic compression bracing

    A dynamic compression system worn 12 or more hours a day for pectus carinatum. Highly effective in growing adolescents.

  • Nuss procedure

    A minimally invasive bar placed under the sternum through small lateral incisions and left in place for two to three years. Gold standard for adolescent excavatum.

  • Modified Ravitch

    An open chondrosternoplasty with cartilage resection and sternal osteotomy. Suited to asymmetric, mature adult and acquired deformities.

  • Abramson procedure

    A minimally invasive approach for pectus carinatum using a bar placed on the front of the sternum.

  • Poland syndrome reconstruction

    Latissimus dorsi flap, custom silicone implant and, where needed, staged breast reconstruction in specialist plastic surgery hands.

  • Post-operative recovery

    Thoracic epidural for pain, early physiotherapy and a graded return to activity over three to six months.

What this guide is based on

The sources behind every claim on this page.

International consensus statements and UK specialist thoracic surgery practice, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or thoracic surgeon knows your chest and history and can tell you which parts apply to you. If in doubt, get seen.

  • Chest Wall International Group (CWIG). Consensus statements on pectus assessment and management.

  • Kelly RE et al. Nuss procedure outcomes and long-term data.

  • European Association for Cardio-Thoracic Surgery (EACTS). Chest wall deformity resources.

  • NHS specialist thoracic services. Referral pathways for chest wall deformity in the UK.

Red flags

When a chest wall deformity needs urgent attention.

Most deformities are managed at a paced specialist clinic. These are the situations that need faster review.

  • Rapid progression at puberty

    A deformity that visibly deepens during a growth spurt needs specialist review before the chest becomes rigid.

  • Cardiac compression symptoms

    Chest pain on exertion, syncope, sustained palpitations or documented arrhythmia should be assessed urgently.

  • Significant restrictive lung disease

    A falling FVC with recurrent infections points to a chest wall contribution and warrants surgical consideration.

  • Marfan or Ehlers-Danlos features

    Aortic root dilatation, lens dislocation or striking hypermobility need cardiology and genetics review alongside chest wall care.

  • Suicidal ideation from body image

    Severe psychological distress linked to appearance is a red flag and needs urgent mental health support.

  • Post-traumatic flail chest

    Multiple rib fractures with paradoxical movement is a separate emergency, covered on our broken ribs guide.

  • Sternal cleft in a neonate

    A midline defect of the sternum in a newborn needs neonatal surgical assessment for primary closure.

  • New deformity after cardiac surgery

    Sternal instability or asymmetry after cardiothoracic surgery should be reviewed by the operating team.

  • Recurrent post-operative pain

    Persistent pain after Nuss or Ravitch beyond expected recovery warrants specialist review for bar-related issues.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day: steady exercise, patient use of non-operative devices, peer support and a specialist team.

A quiet reminder

Consistency beats intensity, every time.

Whether it is daily brace wear or graded post-operative rehab, small habits kept up for months do more than a heroic week that does not last.

  1. 01 Movement

    Keep moving during treatment

    Aerobic exercise, swimming and posture work protect lung function and morale, whether or not you have surgery.

  2. 02 Patience

    Non-operative treatment takes time

    Vacuum bells and dynamic braces work over months to years. Consistency of daily wear matters more than intensity.

  3. 03 Support

    Peer and psychological support

    Cure Pectus and UK chest wall deformity support communities help with body image and the decision about surgery.

  4. 04 Team

    Use a specialist centre

    UK chest wall services at Great Ormond Street, Royal Brompton, Papworth, Wythenshawe, Newcastle Freeman, Birmingham and Leeds handle both routine and complex cases.

Frequently asked

Everything we get asked about chest wall deformities.

Quick answers on excavatum and carinatum, vacuum bells and braces, Nuss and Ravitch surgery, and UK specialist care.

  • What are chest wall deformities?

    A group of congenital and acquired conditions where the ribs, costal cartilages or sternum are shaped abnormally. Pectus excavatum (funnel chest) and pectus carinatum (pigeon chest) are the most common, alongside Poland syndrome, sternal cleft and post-surgical or post-traumatic deformities.

  • When is pectus excavatum serious rather than cosmetic?

    A Haller index above 3.25 on chest CT, along with cardiac or pulmonary compression, reduced FVC, exercise limitation, palpitations or documented arrhythmia, moves a case from cosmetic to clinically significant and worth a surgical opinion.

  • Does a vacuum bell really work?

    In adolescents with flexible chest walls, daily vacuum bell use for one to three years can produce meaningful correction of pectus excavatum. Results are best when treatment starts before the chest stiffens in the mid to late teens.

  • Is the Nuss procedure the best option?

    It is the gold standard for adolescent pectus excavatum in most UK specialist centres. A pre-shaped metal bar is placed under the sternum through small lateral incisions, rotated to push the sternum forward and left in place for two to three years. Modified Ravitch is preferred for asymmetric, mature adult or acquired deformities.

  • How is pectus carinatum treated?

    A dynamic compression brace worn 12 or more hours a day is highly effective in growing adolescents. Surgery, such as the Abramson procedure or a modified Ravitch, is reserved for rigid chests or when bracing fails or is declined.

  • Where should I be seen in the UK?

    Specialist chest wall services include Great Ormond Street, Royal Brompton, Papworth, Wythenshawe, Newcastle Freeman, Birmingham and Leeds. Ask your GP for a referral to a designated chest wall MDT rather than to a general surgical clinic.

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