Pectus Excavatum

Western Toronto Thoracic Associates

Pectus excavatum is the most common congenital chest wall defect (8/1000 live births). The defect arises when excessive or unequal growth of the lower costal cartilages pushes the sternum posteriorly resulting in a depression of the anterior chest wall. The severity of the defect ranges from a minor degree of deformity to a severe concavity that displaces mediastinal organs.

Pectus excavatum can lead physical problems such as:

  • Chest pain
  • Difficulty breathing
  • Diminished exercise tolerance
  • Fainting spells

Pectus excavatum can also lead to emotional issues such as:

  • Poor self-image, self-esteem
  • Depression
  • Avoidance of social situations (swimming, sunbathing, sports)
  • Difficulty with social interactions


There are two methods of repair

Ravitch Procedure

Western Toronto Thoracic Associates

Deschamps C, Operative Techniques in Thoracic Surgery, 2007

This involves a midline incision in the chest, removal of the affected cartilages, and insertion of a metal bar behind the sternum to allow the breast bone to heal in the new position.

Western Toronto Thoracic Associates

Minimally-Invasive Nuss Procedure

Western Toronto Thoracic Associates

This novel technique involves the minimally invasive insertion of a metallic bar behind the breastbone, which pushes it forwards and corrects the deformity. This technique is favorable since the surgical scar is not in a location which is easily concealable.


We at the Western Toronto Thoracic Associates perform more of these types of surgery than any other thoracic centre in Ontario. We also have the largest published experience with this technique in adult patients in North America1. We have had excellent results with 92.1% of patients reporting an improvement in the appearance of their chest following the procedure. Our patients also reported significantly improved self-esteem following the procedure. Overall, 96% of our patients were satisifed and, if given the chance, would have the procedure again1.

Schedule your appointment with one of our surgeons today. There are pros and cons for each type of procedure. Together you can discuss a treatment plan that is right for you.

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1) Ann Thorac Surg.
2013 Sep;96(3):1033-6; discussion 1037-8. doi: 10.1016/j.athoracsur.2013.04.093. Epub 2013 Jun 25.

Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction.
Hanna WC1, Ko MA, Blitz M, Shargall Y, Compeau CG.