Spine & Chest

    Pectus Excavatum in Adolescents: Vacuum Bell or Nuss Procedure?

    Sunken sternum: when pectus excavatum requires cardiac evaluation, a vacuum bell, or the Nuss procedure.

    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. Its use is set up and followed by the paediatric thoracic surgery team, to whom the patient is referred after the initial orthopaedic assessment.
    See all 5 questions →
    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. The orthopaedic assessment is primarily clinical and considers morphology, depth and flexibility of the deformity, symptoms (exercise tolerance, dyspnea, palpitations), psychosocial impact, and any associations with posture or spine alignment. When indicated, cardiac, respiratory, and imaging workup is added to quantify the deformity and rule out compression of internal structures. In mild-to-moderate flexible forms, postural exercises and trunk strengthening may be recommended. For structured options — such as the vacuum bell or, in severe symptomatic forms, surgical correction (e.g. the minimally invasive Nuss procedure) — the pathway is a referral to a dedicated paediatric thoracic surgery team, ideally within a multidisciplinary evaluation.

    Assessment and treatment

    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
    • Referral to a paediatric thoracic surgery team for vacuum bell assessment in selected flexible deformities
    • Referral to a paediatric thoracic surgery team for 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. Its use is set up and followed by the paediatric thoracic surgery team, to whom the patient is referred after the initial orthopaedic assessment.
    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. When surgical correction is being considered, the patient is referred to a dedicated paediatric thoracic surgery team, and 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.

    We use necessary technical cookies and, only with your consent, aggregated statistics.

    Details

    With consent we enable Google Analytics 4, Google Ads conversion measurement (anonymized IP, no profiling or remarketing) and Microsoft Clarity, which analyses site usage with heatmaps and session recordings: sensitive content (form fields and the chat window) is masked and the data is not used for profiling or remarketing. The MioDottore (Docplanner) booking service loads only when you click the booking button.

    Privacy Policy