Funnel breast

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

A funnel chest (pectus excavatum) is a congenital malformation in which the lower part of the sternum arches inwards and takes on the shape of a funnel. Read here how a funnel breast is created, which complaints occur and how it is treated!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. Q67

Brief overview

What is a funnel breast? Congenital malformation of the sternum and ribs. The sternum is arched inwards in the lower area. When viewed from the front, the rib cage is funnel-shaped.
Treatment: physiotherapy, suction cup, neuromuscular muscle stimulation. Surgery is rarely necessary.
Course and prognosis: The funnel breast often shows up in the first year of life and intensifies with growth and puberty. With timely treatment, the prognosis is very good.
Symptoms: A funnel chest rarely causes physical complaints, for example back pain, spinal curvature, asymmetrical breasts, impaired heart and lung function. Much more often, severe psychological stress is the result.
Causes: Disruption of cartilage and bone growth in the area of the anterior chest wall. How this comes about is unknown. In a third of all those affected, the funnel breast occurs in families.
Risk factors: scoliosis, Marfan syndrome and Poland syndrome, fetal alcohol syndrome, vitamin deficiency
Diagnostics: visual diagnosis, chest x-ray, magnetic resonance imaging, pulmonary function tests, heart examination
Prevention: As it is a congenital disease, prevention is not possible.

What is a funnel breast?

A funnel chest (pectus excavatum) is a mostly congenital deformation of the chest in which the sternum bulges inwards, especially in the lower area. When viewed from the outside, the front chest wall has the shape of a funnel. Typically four to five ribs per side and the sternum are affected.

The sternum is sunken symmetrically or asymmetrically, depending on the case. Especially with asymmetrical shapes, it happens that the breasts of affected girls and women are of different sizes and shapes.

In most cases, the funnel breast is congenital; it rarely only develops in the course of life as a result of previous illnesses or injuries.

frequency

The funnel chest is the most common congenital deformity of the chest. On average, it affects one in 400 newborns, boys four to five times more often than girls. In around a third of all those affected, at least one other family member has a funnel breast (familial accumulation).

Keel breast

A so-called keel breast (pectus carinatum, chicken breast) is the opposite of the funnel breast. The sternum and the adjacent ribs do not curve inwards in a funnel shape, but outwards. The protrusion occurs much less often than the depression and usually does not develop until puberty. The cause is an overgrowth of the cartilage connection between the ribs and the sternum.

People with a keel chest usually suffer from severe psychological stress and improper stress on the spine (back pain, scoliosis) - but serious health problems are rare. An operation is necessary if the keel chest is so pronounced that it restricts breathing. In all other cases, an attempt is made to continuously push back the protrusion with the help of a custom-made pressure brace (pressure bandage).

What can you do about a funnel breast?

Whether and how a funnel breast is treated depends on the extent of the malformation and the age of the patient. Basically, a funnel breast is easy to treat.

A light funnel breast usually does not require medical treatment, but many sufferers want this for aesthetic reasons. Reasons in favor of therapy are pronounced forms that affect the heart and lungs or cause severe psychological stress.

There are various approaches to treating a funnel breast: physiotherapy, treatment with a suction cup, placing an implant or an operation.

Suction bell

If the chest wall is slightly retracted, treatment with a special suction cup achieves good results. It is suitable for children from around six years of age. The suction cup is made of orthopedic silicone and can be individually adapted to the patient. It is placed on the chest and creates a negative pressure that lifts the chest.

With daily use for one to three hours, the suction cup therapy lasts about three years. The effect is strongest in the first three months, from then on the funnel decreases by 1 mm per month. In addition, doctors recommend regular posture training and muscle building.

The suction cup is built in such a way that it can be worn under clothing - even during sports. Depending on the size of the chest and the size of the deformation of the chest, there are different suction bells. Special models are available for girls and women during and after breast development.

physical therapy

As long as the body is growing, physiotherapy is a good way to counteract the funnel chest and the associated poor posture through physiotherapy. Whether a funnel breast can be "trained away" with exercises depends heavily on its characteristics.

With daily training - in the morning and in the evening for ten minutes - those affected expand the chest further and work on their posture. Exercises to strengthen the back and chest muscles as well as to expand the chest are particularly suitable.

Exercises to strengthen the back

Cross your hands behind your head, hook your fingers together.
Push your elbows back as far as possible, keeping your head and neck straight. This pose brings the rib cage forward.
Bend the still stretched upper body forward at the hips. Hold position for two to three seconds, 25 repetitions. This exercise strengthens the back and brings the shoulders back.

Exercise to strengthen the chest muscles

Lie on your back on the floor, arms outstretched.
Light weights in both hands, then extend arms together over chest, 25 reps.
25 push-ups per day (in the case of an operation, only from the fourth month afterwards)

Exercise to expand the chest

Back straight, shoulders back.
Breathe in as deeply as possible and hold your breath as long as possible. 20 repetitions twice a day.

Exercise immediately after getting up and before going to bed and no longer than ten minutes each time!

Endurance sports such as swimming or jogging also have a positive effect on the funnel chest.

Implant

If the funnel breast does not cause any discomfort or restrictions, but is perceived as annoying, it can be optically balanced with a made-to-measure implant - which is placed under the skin - or with autologous fat. However, this procedure is only carried out in adulthood.

Neuromuscular electrical stimulation (NMES)

If there is an incorrect posture of the spine, targeted neuromuscular electrical stimulation is suitable to strengthen the back muscles and improve the stability of the trunk. Muscles and nerves are stimulated with small electrical surges.

surgery

The doctor then performs an operation if the funnel chest is very pronounced (Haller index greater than 3.2), asymmetrical or very psychologically stressful for the person concerned.

Operation method according to Donald Nuss: It is particularly suitable for children between the ages of twelve and 16. A metal bracket is passed under the breastbone, which pushes the depression of the breastbone outwards and thus eliminates the funnel. The bracket is removed after three years.

Stabilization with metal plates: In this method, the doctor stabilizes the sternum with metal plates and wire sutures. They are usually removed after a year.

After the operation

After the funnel breast surgery, it takes several weeks before the patient can return to his normal everyday life. The following must be observed after the procedure:

1st to 6th week after the operation:

The doctor will gradually stop the pain relievers you received after the operation.
Do not raise your arms above your head for the first two weeks after the operation!
Sleep on your back for the first four weeks.
Do not do sports, you can go for a walk.

6th to 12th week after the operation:

Physiotherapy begins now.
Slowly increase your daily activities.
Do not rotate your upper body!
Swimming, jogging, cycling and driving a car are possible with no pain.
Do not carry backpacks or school bags!
Do not lift heavy loads over 20 kg!

After the 12th week after the operation:

Normal physical activity is now possible again.
Keep doing physiotherapy on a regular basis.
Permanently avoid contact sports such as ice hockey, football, boxing, wrestling or karate!

The health insurance company will assume the costs

The health insurance companies cover the costs for diagnostics. Whether the costs of the treatment are also covered depends on how severe the physical complaints are. In principle, the following applies: the more pronounced the funnel breast and the clearer the complaints, the more likely the health insurance company will cover the treatment costs.

A strong psychological impairment as a result of the deformation can be proven by a psychological report. In the case of purely cosmetically motivated interventions, the patient usually bears the costs himself. The costs for the operation amount to up to 10,000 euros, excluding hospitalization, which has to be paid additionally.

Talk to your doctor about a possible reimbursement of the treatment costs by the health insurance company!

Is a funnel breast dangerous?

A funnel chest rarely causes physical complaints, but often causes psychological stress. However, if the indentation is very deep, it is possible that it displaces internal organs such as the heart and lungs and restricts their function. In these cases, surgery can help.

Life expectancy

Since a funnel breast can usually be treated well, those affected have a normal life expectancy. If the funnel breast is a symptom of another underlying disease, life expectancy may be impaired.

How do I recognize a funnel breast?

Which symptoms occur depends on how pronounced the funnel breast is. If the lowering of the sternum is only slight, there are hardly any physical complaints. In more severe cases, however, the displacement of the heart and lungs leads to functional disorders of the organs. Overall, physical complaints are rather rare.

In babies, the funnel is sometimes invisible or only slightly visible, but it is usually clearly visible within the first year of life. Typically, the funnel becomes stronger during the growth phase and puberty and then sometimes leads to discomfort.

Symptoms triggered by the funnel chest

Paradoxical breathing in the toddler (the chest moves inwards when inhaling and outwards when exhaling)
Lower back and back pain due to poor posture
Chest pain
Drooping and protruding shoulders, protruding abdomen, hollow back, hunched back
Curvature of the spine (scoliosis)
The ribs on the lower costal arch may protrude a little.
Emotional suffering due to the aesthetic impairment: Even if a funnel breast does not usually pose a health risk, many sufferers struggle with a reduction in their quality of life. They often have little self-esteem and avoid going to swimming pools, for example, in order not to have to show themselves bare-chested in public.
From the outside, the patients have an indentation at the level of the nipples. This "funnel" can be both symmetrical and asymmetrical and accordingly be lower on one side than on the other. In women, there is usually an asymmetry of the breast, which can be psychologically very stressful.
If the funnel chest is pronounced, the heart and lungs may constrict. During intense physical exertion, palpitations and shortness of breath occur
More frequent infections of the lungs and bronchi.

Consequences of the funnel breast

With the onset of puberty, the funnel breast is usually the most pronounced in the individual. Those affected then often get into a kind of "vicious circle":

Because of the lower resilience and chest pain, those affected are often less active.
They perceive the changed appearance more strongly and withdraw.
They avoid sporting activity so that others cannot see their self-perceived flaws and increasingly find themselves in social isolation.
The lack of physical activity weakens the chest and back muscles, which leads to the funnel chest becoming stronger.

Causes and Risk Factors

The cause of the formation of the funnel breast is a disruption of the cartilage and bone growth in the area of the chest. As a result, the costal cartilage grows uncontrollably - the sternum bulges inwards (funnel chest) or outwards (keel chest). How this comes about is unclear. Since the funnel breast is familial in a third of all patients, doctors assume a certain genetic predisposition.

Risk factors

The funnel breast is not always the only (isolated) disease, in some cases there are other diseases that favor a funnel breast:

Scoliosis: In scoliosis, the spine is curved to the side in an S-shape. As a result, the chest may sink in.

Marfan Syndrome: This is a congenital disease of the connective tissue. In addition to a funnel chest, those affected often have disproportionately long arms and legs, overstretchable joints, heart valve defects and eye problems.

Poland Syndrome: In Poland Syndrome, the mammary gland and pectoral muscle on one side of the body are malformed, the affected breast is smaller than the healthy one. A funnel breast is also common.

Fetal alcohol syndrome: Alcohol consumption during pregnancy can cause serious harm to the unborn child: In addition to mental impairment and certain facial features, many sufferers have a funnel-shaped breast.

Vitamin deficiency: In very rare cases, the funnel breast is the result of a vitamin deficiency. Since vitamin D plays an important role in the development of bone tissue, a permanent deficiency (rickets) can lead to malformations on the skeleton, such as a funnel breast, among other things.

Investigation and diagnosis

The pediatrician is the first point of contact if a funnel breast is suspected. In the newborn it is possible that the retraction of the sternum is only slightly visible or, under certain circumstances, not at all. After puberty at the latest, a look at the chest is sufficient to diagnose a funnel breast. The doctor usually refers the patient to an orthopedic surgeon or surgeon for further clarification.

First, the doctor measures the deformation and documents it with photos from different perspectives. To determine whether the deformation is affecting internal organs such as the heart or lungs (by displacing the organs), the doctor will conduct further examinations. These include:

X-ray examination: the doctor uses X-rays (from the front and the side) to visualize the bone structures.

Magnetic resonance imaging (MRI) of the chest: MRI is used to produce cross-sectional images of the chest. The so-called “Haller index” is calculated by evaluating these images: It results from the greatest distance between the right and left ribs, divided by the smallest distance between the sternum and the spine. The higher the index, the more pronounced the funnel breast. Healthy people have an index of 2.5.

Spirometry: With the help of spirometry the lung function is examined.

Spiroergometry: The lung function is tested under physical stress.

Examination of the heart: examinations to determine whether the heart is affected by the deformation include blood gas analysis, heart rate measurement, blood pressure measurement, electrocardiogram (EKG) and heart ultrasound.