Medically reviewed by Dr Ivan Schewitz, Cardiothoracic Surgeon (Heart, Lung & Chest Specialist). A specialist in cardiothoracic surgery since 1985, Dr Schewitz introduced the minimally invasive Nuss procedure for pectus excavatum to South Africa and has delivered more than 40 cardiothoracic presentations, several focused on pectus repair.
Pectus Clinic SA · Last updated July 2026
In short: Pectus excavatum, a sunken or “funnel” chest, is more than a change in appearance. In moderate to severe cases the breastbone presses on the heart, reducing exercise capacity, energy and quality of life. Modern minimally invasive surgery can relieve this pressure and, in appropriately selected patients, improve heart function.
For many years, pectus excavatum, often called a “sunken chest” or “funnel chest”, was thought to be little more than a cosmetic condition. Many children and adults were told that although their chest looked different, it would not cause any real medical problems.
We now know that this is not always true.
While mild pectus excavatum may cause little or no physical impairment, moderate and severe deformities can place significant pressure on the heart, affecting exercise capacity, breathing, energy levels and quality of life. Even more remarkable is that many patients only realise how much the condition affected them after it has been corrected.
The Heart Has Very Little Room to Move
Your heart sits immediately behind your breastbone (sternum). In a normal chest, there is enough space for it to expand and contract freely with every heartbeat.
In pectus excavatum, the breastbone is pushed backwards towards the spine.
As the chest sinks inward, the heart is squeezed into a smaller space. Rather than pushing the breastbone forward, the heart simply adapts to the pressure.
Over many years, this compression becomes “normal” for the patient.
The Right Side of the Heart Is Most Affected
The part of the heart most commonly compressed is the right ventricle.
This chamber receives blood returning from the body and pumps it to the lungs to pick up oxygen. Because it lies directly behind the sternum, it bears the greatest pressure from the sunken chest.
When the right ventricle cannot fill properly:
- less blood reaches the lungs
- less oxygenated blood returns to the body
- the heart cannot increase its output during exercise as efficiently as it should.
This is why many patients describe themselves as “never being very fit,” even though they have no lung disease or other medical problems.
Many People Don’t Realise Anything Is Wrong
One of the fascinating aspects of pectus excavatum is that symptoms often develop gradually.
Children adapt. Teenagers assume everyone feels exhausted after sport. Adults believe they are simply getting older or becoming less fit.
Because they have lived with the condition their entire lives, they have no idea what “normal” exercise capacity should feel like.
Patients commonly describe:
- Tiring more quickly than friends
- Becoming breathless on hills or stairs
- Poor endurance during sport
- Difficulty keeping up with teammates
- Reduced stamina despite regular exercise
- Chest discomfort during exertion
- Occasional palpitations.
These symptoms are frequently blamed on poor fitness, asthma or anxiety when, in reality, the heart is working under mechanical restriction.
Can Pectus Excavatum Affect Elite Athletes?
Yes. Some competitive athletes perform remarkably well despite severe pectus excavatum because their bodies compensate extremely effectively.
However, even highly trained athletes may notice that they cannot reach the performance levels expected despite intensive training.
Following surgical correction, many athletes report noticeable improvements in endurance, recovery and exercise performance.
How Do We Know the Heart Is Being Compressed?
Modern imaging has transformed our understanding of pectus excavatum.
- An echocardiogram (heart ultrasound) can often show the right ventricle being flattened by the breastbone.
- CT scans demonstrate how the heart has been pushed towards the left side of the chest.
- Cardiopulmonary exercise testing (CPET) measures exactly how the heart and lungs perform during exercise and often reveals reduced exercise capacity that patients never realised they had.
Taken together, these tests provide objective evidence that the deformity is affecting heart function rather than simply changing the appearance of the chest.
Does Surgery Really Improve Heart Function?
This is perhaps the most exciting development over the past decade.
International studies have shown that correcting pectus excavatum can improve cardiac filling and output in appropriately selected patients.1,2
When the breastbone is lifted into its normal position during a minimally invasive repair (commonly known as the Nuss procedure), the heart immediately has more room.
The compressed right ventricle expands towards its normal shape. Blood flows more freely through the heart. Cardiac output, the amount of blood the heart pumps each minute, increases.
Patients often notice:
- easier breathing
- increased energy
- improved exercise tolerance
- faster recovery after physical activity
- better endurance
- less chest discomfort
- improved confidence.
Many describe the change in surprisingly similar words: “I never realised how limited I was until after the operation.” For some, it is the first time they have experienced what normal exercise feels like.
It’s Not Just About Exercise
Improved heart function affects everyday life. Patients often find they have more energy at work or school. Children participate more confidently in sport. Teenagers become more socially active. Adults enjoy activities they had quietly stopped doing years before.
Combined with the significant improvement in body image and self-confidence, the overall change in quality of life can be remarkable.
Is Surgery Recommended for Everyone?
No. Not every patient with pectus excavatum requires surgery. Many people with mild deformities have completely normal heart and lung function and may simply require observation.
The decision to operate depends on several factors, including:
- the severity of the chest deformity
- evidence of heart compression
- breathing function
- exercise limitation
- symptoms
- psychological impact.
Each patient should undergo a comprehensive assessment before deciding on treatment.
The Importance of Expert Assessment
One of the biggest misconceptions about pectus excavatum is that the appearance of the chest tells the whole story. It does not.
Some patients with dramatic-looking deformities have surprisingly normal heart function, while others with less obvious chest changes have significant compression of the heart. This is why specialist assessment is so important.
At Pectus Clinic SA, every patient undergoes a detailed evaluation that may include CT imaging, echocardiography, lung function testing and cardiopulmonary exercise testing. These investigations help determine whether the chest wall is affecting the heart and lungs and whether surgical correction is likely to provide meaningful benefit.
The Bottom Line
Pectus excavatum is far more than a cosmetic condition. For many people, particularly those with moderate or severe deformities, the sunken breastbone compresses the heart, limiting its ability to function efficiently during exercise and everyday activities.
The encouraging news is that modern surgical repair can restore the normal position of the chest wall, relieve pressure on the heart and significantly improve exercise capacity, breathing and overall quality of life.
If you or your child has pectus excavatum and experiences breathlessness, reduced fitness or chest discomfort, it is worth asking one simple question: is the heart being compressed?
A specialist assessment can provide the answer, and for many patients, it is the first step towards a healthier, more active life.
Book an assessment at Pectus Clinic SA
Concerned about pectus excavatum for yourself or your child? Request a specialist assessment.
Medical disclaimer: This article is for general information only and is not a substitute for personalised medical advice. If you are concerned about pectus excavatum or any related symptoms, please consult a qualified specialist.
References
- Maagaard M, Heiberg J. Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature. Ann Cardiothorac Surg. 2016;5(5):485-492. PMC5056930
- Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg. 2012;41(5):1063-1067. doi:10.1093/ejcts/ezr170
- NHS, Pectus excavatum (overview and treatment): nhs.uk/conditions/pectus-excavatum.
