Spine & Chest

    Pectus Excavatum in Adolescents: Vacuum Bell or Nuss Procedure?

    Is your child's sternum sunken? Learn when pectus excavatum needs cardiac evaluation, vacuum bell, or the Nuss procedure. Milan specialist.

    Medically reviewed: April 2026·Dott. Daniele Priano

    Quick Answers

    Is pectus excavatum dangerous for heart and lungs?
    In more severe forms the sternum can compress the heart and reduce space available to the lungs, in some cases causing reduced exercise tolerance, palpitations or breathing difficulties. For this reason, when clinically indicated, cardiological and respiratory workup is offered. Mild-moderate forms are more often an aesthetic issue, without significant functional repercussions.
    How does the vacuum bell work?
    The **vacuum bell** is a silicone device that, applied to the chest, creates negative pressure with the goal of progressively lifting the sternum. It must be worn several hours a day for many months and results vary: it tends to be more indicated in young patients with flexible chest and contained deformity. The choice is always agreed case by case.
    When is the Nuss procedure considered?
    The **Nuss procedure** is a minimally invasive technique that involves placing a metal bar behind the sternum, removed after several years once correction is consolidated. It is considered in severe symptomatic forms or with significant psychosocial impact, ideally in adolescence when the chest is still remodelable. The decision is shared multidisciplinarily with the teenager and family.
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    Pectus Excavatum in Adolescents: Vacuum Bell or Nuss Procedure? - Pediatric Orthopaedics Milan Dr. Priano

    Pectus excavatum is the most common chest wall deformity, characterized by a posterior depression of the sternum and costal cartilages. It predominantly affects males and tends to worsen during the pubertal growth spurt. Assessment is primarily clinical and considers morphology, depth and flexibility of the deformity, symptoms (exercise tolerance, dyspnea, palpitations), and psychosocial impact. When indicated, cardiac, respiratory, and imaging workup is added to quantify the deformity and rule out compression of internal structures. Care is tailored: in flexible mild-to-moderate forms a conservative approach may be considered (postural exercises, strengthening, in selected cases the vacuum bell); in severe symptomatic forms or those with significant impact on the adolescent, a surgical approach is discussed (typically the minimally invasive Nuss procedure). Timing and modalities are decided case by case, ideally within a multidisciplinary team.

    When to seek evaluation

    • Visible sternal depression
    • Psychological discomfort related to appearance
    • Reduced exercise tolerance, dyspnea, palpitations
    • Worsening during pubertal growth
    • Family history of pectus or Marfan syndrome

    What is evaluated

    • History and reported symptoms
    • Clinical and photographic assessment
    • Flexibility of the chest wall
    • Cardiac and respiratory workup when clinically indicated
    • Advanced imaging in candidates for surgical treatment
    • Consideration of family history or suspected associated syndromes

    Treatment options

    • Observation and reassurance in mild forms
    • Postural physiotherapy and trunk strengthening
    • Vacuum bell in selected flexible deformities
    • Surgical evaluation (e.g. Nuss procedure) in severe or symptomatic forms
    • Multidisciplinary discussion in more complex cases

    Frequently Asked Questions

    Is pectus excavatum dangerous for heart and lungs?▼
    In more severe forms the sternum can compress the heart and reduce space available to the lungs, in some cases causing reduced exercise tolerance, palpitations or breathing difficulties. For this reason, when clinically indicated, cardiological and respiratory workup is offered. Mild-moderate forms are more often an aesthetic issue, without significant functional repercussions.
    How does the vacuum bell work?▼
    The **vacuum bell** is a silicone device that, applied to the chest, creates negative pressure with the goal of progressively lifting the sternum. It must be worn several hours a day for many months and results vary: it tends to be more indicated in young patients with flexible chest and contained deformity. The choice is always agreed case by case.
    When is the Nuss procedure considered?▼
    The **Nuss procedure** is a minimally invasive technique that involves placing a metal bar behind the sternum, removed after several years once correction is consolidated. It is considered in severe symptomatic forms or with significant psychosocial impact, ideally in adolescence when the chest is still remodelable. The decision is shared multidisciplinarily with the teenager and family.
    Is pectus excavatum hereditary?▼
    There is a **genetic component**: family history is found in a significant proportion of cases. Pectus excavatum can also be associated with **Marfan syndrome** or other connective tissue disorders. For this reason, in the presence of a very elongated chest, joint hypermobility or other suggestive signs, genetic or cardiological investigation may be proposed.
    Can worsening during growth be prevented?▼
    There are no treatments that completely prevent progression, but **postural physiotherapy** and **trunk muscle strengthening** can improve posture and partially mask the deformity. Maintaining good posture (avoiding kyphotic compensation) is important. In selected cases, early initiation of vacuum bell may be considered to limit worsening.

    Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.

    Dott. Daniele Priano

    Is your child's sternum sunken?

    For information or questions, contact me.

    PrenotaContatti

    Email: daniele.priano@ortopediaevolutiva.com

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