Having a concave or sunken chest, also known as pectus excavatum or “bird chest,” can make some people feel self-conscious about their appearance. While it is not usually a medical concern, some may want to improve the look of their chest for cosmetic reasons. There are a few options available to help get rid of bird chest appearance.
What causes bird chest?
Bird chest is caused by an overgrowth of cartilage that connects the ribs to the breastbone (sternum), forcing the sternum to grow inward instead of outward. This creates a sunken or caved-in look in the middle of the chest. Pectus excavatum is congenital, meaning it develops in the womb, though symptoms may not be noticeable until puberty when the cartilage overgrows. The exact cause is unknown but it tends to run in families and occurs more often in boys than girls.
When is surgical correction needed?
In most cases, bird chest does not cause any physical symptoms or health problems. However, for some the deformity is severe enough to compress the heart and lungs, leading to:
- Shortness of breath, especially during exercise
- Fatigue
- Chest pain
- Heart palpitations
- Lightheadedness
People with moderate to severe cartilage overgrowth and the above symptoms may need surgery to correct bird chest. This is known as pectus excavatum repair or correction surgery. It is generally recommended once skeletal growth is complete, typically around age 18.
Nonsurgical treatments for cosmetic improvement
For those seeking cosmetic improvement of mild to moderate bird chest, there are a few nonsurgical treatment options to consider:
Posture training
Poor posture can exacerbate the sunken chest appearance. Training yourself to stand up straight with your shoulders back can help protrude your chest, minimizing the caved-in look. Work on posture retraining by:
- Doing exercises like wall angels to open up the chest
- Using posture reminders like shoulder back tape
- Avoiding slouching when sitting at a desk or standing
Pectus excavatum exercises
Certain strength training exercises may help improve the appearance of mild cases of bird chest:
- Chest presses: Lying flat on the floor, place small weights in each hand and extend arms straight up over chest, palms facing in. Bend arms and lower weights toward chest, then press back up.
- Seated rows: Using resistance band or cable machine, sit up straight pulling shoulders back. Pull band/handles toward chest, squeezing shoulder blades together.
- Dumbbell flies: Lying flat, hold dumbbells at shoulder level with arms extended out to sides. Keeping elbows slightly bent, lower weights out to side then raise back to starting position.
Aim to do 2-3 sets of 10-15 repetitions of each exercise 2-3 times per week. Building up chest and back muscles can help bring the protrusion of the sternum forward.
Vacuum bell exercises
Using a vacuum bell device can help strengthen chest muscles and improve the appearance of minor to moderate pectus excavatum. A vacuum bell looks like a suction cup that you place over the sunken part of your chest. Create a vacuum by pumping out the air which pulls the depressed sternum outward. Vacuum bell exercises involve:
- Placing the vacuum bell over sunken chest area
- Pumping air out to form suction and pull sternum out
- Holding for 30 seconds to 2 minutes
- Releasing suction and repeating 3-5 times per session
Aim for vacuum bell exercises twice per day. Results are gradual and take consistency over months. Always consult your doctor before using a vacuum bell.
Bracing
Wearing a brace can also help bring the sternum forward for a temporary change in appearance. Bracing options include:
- Compression vests – Tight fitting vest that puts pressure on chest to push sternum out
- Medical chest bracing – Custom bracing that maintains correct posture
- Posture braces – Less rigid braces that provide back and shoulder support for better posture and chest projection
Drawbacks of bracing include only providing temporary change while worn and potential skin irritation.
Surgical procedures to correct bird chest
For significant cosmetic improvement of bird chest, surgery is typically required. There are two main surgical procedures:
Ravitch procedure
This involves:
- Making an incision across the entire chest
- Removing abnormal costal cartilage
- Re-attaching ribs to sternum in normal position
- Inserting metal bar to hold sternum protruded
The metal bar remains in place for 2-3 years until the chest maintains proper shape. This open surgery has a long, visible scar but excellent long-term results.
Nuss procedure
This less invasive procedure inserts a curved metal bar behind the sternum through two small incisions on side of chest. The bar pushes out and corrects the deformity. It remains in place for 2-3 years. Benefits include no visible scar on chest and shorter recovery. But it has higher complication rate than the Ravitch procedure.
Ravitch procedure | Nuss procedure |
---|---|
Involves long incision across chest | Inserts bar through two small side incisions |
Removes abnormal cartilage | Does not remove cartilage |
Low complication rate | Higher complication rate |
Long recovery period | Shorter recovery time |
Excellent long-term results | Good long-term improvement |
Factors that influence results
Several factors play a role in the potential results you can achieve in improving bird chest appearance:
- Severity – Mild cases respond better to nonsurgical treatments compared to severe deformity.
- Age – Surgery ideally done after chest fully developed, around 18 years old.
- Technique – Surgeon experience and surgical technique influence surgical results.
- Smoking – Smoking impedes healing after surgery so must quit before and after.
- Follow up care – Consistency with posture retraining, exercises, bracing improves outcomes.
Consulting an experienced surgeon helps set realistic expectations for improvement based on your individual case.
Potential complications
While relatively safe procedures when done by an experienced surgeon, potential complications to be aware of include:
- Infection
- Bleeding
- Seroma – Fluid buildup under skin
- Pneumothorax – Collapsed lung
- Hemothorax – Blood collection around lungs
- Hardware shifting
- Recurrence of deformity
- Numbness or nerve damage
- Unsatisfactory cosmetic results
Carefully following your surgeon’s pre- and post-op instructions helps minimize risks.
Recovery after bird chest surgery
Recovery time after surgery depends on the procedure:
- Ravitch procedure – Hospital stay is 4-7 days. Return to normal activity takes 4-6 weeks. Can resume exercise in 2-3 months.
- Nuss procedure – Hospital stay averages 3 days. Return to normal activity in 2-3 weeks. Can resume exercise in 4-6 weeks.
Typical recovery process involves:
- Wearing a postoperative brace for 6-8 weeks
- Using pain medication for 1-2 weeks to control discomfort
- Starting gentle physical activity after 2-3 weeks
- Avoiding vigorous exercise and heavy lifting for 2 months
- Follow-up appointments to monitor progress
Full results are not visible until 1 year after surgery when swelling resolves and bar is removed. Some numbness can remain for several months.
Cost of treating bird chest
Treatment costs for bird chest include:
- Vacuum bell device – $200-$500
- Compression vest – $100-$300
- Corrective braces – $1,000-$4,000
- Ravitch surgery – $20,000-$40,000
- Nuss procedure – $15,000-$30,000
If surgery is medically necessary, insurance may cover a portion of the cost for children. For adults and cosmetic procedures, insurance does not provide coverage.
Conclusion
While having a sunken chest or bird chest shape is rarely serious, some may seek cosmetic improvement through exercises, bracing, or surgery. Mild cases can often achieve noticeable results from posture exercises, strength training, and using a vacuum bell. For moderate to severe deformity, the Ravitch or Nuss procedures are reliable surgical options to permanently correct the chest profile.
Improving bird chest requires consistency with nonsurgical techniques over a long period. And any surgical intervention carries some risk along with a 2-3 month recovery. Consulting an experienced provider helps determine the options ideal to your individual case and expected goals.