Chest Wall Deformity Treatment In London
Understanding and treating chest wall deformities. Modern surgery, lasting results.
Pectus excavatum, pectus carinatum, pectus arcuatum, and other chest wall anomalies are structural conditions — not cosmetic afterthoughts. Mr Scarci treats the full spectrum of chest wall deformities in teenagers and adults, from minimally invasive Nuss bar insertion to complex chest wall reconstruction.
For patients and families navigating a new diagnosis
If you or a loved one has been diagnosed with a chest wall deformity, you’re not alone — and modern medicine offers more treatment options than ever before.
Chest wall deformities are structural abnormalities of the chest that occur when the costal cartilage connecting the ribs to the breastbone grows abnormally, causing the chest to have an unusual shape. While many people think of these as purely cosmetic concerns, chest wall deformities can affect breathing, heart function, and overall quality of life — and many patients with severe deformities have been incorrectly told that nothing can be done.
What makes chest wall deformities particularly challenging is their visibility. Unlike many medical conditions that remain hidden, they can affect how you feel about your appearance, potentially impacting self-esteem and participation in activities like swimming or sport. These are legitimate medical concerns, not vanity.
“Chest wall deformities affect both function and confidence. My aim is to give every patient — teenager or adult — a clear assessment of their condition, honest information about what surgery can and cannot achieve, and access to the most appropriate corrective procedure for them.”
Chest wall deformities are often associated with scoliosis and connective tissue disorders like Marfan syndrome. They become particularly evident during puberty, though treatment is available and effective across all age groups.
Book a Consultation
Seen within days. No referral needed. Mr Scarci will review your imaging and discuss all options — surgical and non-surgical — at your first appointment.
Call 020 7459 4367
At a glance
Types of chest wall deformity
The most common types involve abnormal growth of the costal cartilage — the flexible connective tissue joining the ribs to the breastbone. Each has distinct characteristics, symptoms, and treatment pathways.
Pectus Excavatum — Sunken Chest
The breastbone (sternum) and several ribs grow abnormally, creating a depression in the centre of the chest. Severity ranges from a mild indentation to a deep hollow that compresses the heart and lungs. In moderate to severe cases, patients may experience breathlessness on exertion, reduced exercise tolerance, chest tightness, and palpitations. Affects around 1 in 300–400 people; three times more common in males.
→ Functional impact is frequently underestimated — a CT Haller index gives objective severity
Pectus Carinatum — Pigeon Chest
The sternum protrudes outward. The functional impact on the heart and lungs is generally less significant than in pectus excavatum, but the physical appearance can cause considerable self-consciousness. Protrusion can be symmetric or asymmetric. The condition often becomes most noticeable during adolescent growth spurts. Bracing is effective when the chest wall is still flexible; surgery is available for severe or adult cases.
→ Custom bracing achieves correction in most adolescents without surgery
Pectus Arcuatum
Also called Currarino–Silverman syndrome or pouter pigeon breast. A rare congenital deformity where the upper sternum protrudes while the lower portion may appear normal or depressed. It is frequently misdiagnosed as pectus excavatum because the chest does sink — but crucially, it also sticks out. Correct diagnosis is essential: the wrong diagnosis leads directly to the wrong treatment. Correction requires a tailored approach combining elements of both excavatum and carinatum techniques.
→ Correct identification is critical — a specialist assessment distinguishes it from other types
Mixed & Complex Deformities
Some patients have a combination: excavatum on one side and carinatum on the other, significant asymmetry, or deformities associated with conditions such as Marfan syndrome, Poland syndrome, or scoliosis. These complex cases require careful evaluation — often with 3D CT imaging — and individually planned chest wall reconstruction. Custom titanium implants are available for selected cases where standard bar techniques are not appropriate.
→ Complex cases benefit most from a surgeon who treats the full spectrum
Associated conditions: Chest wall deformities are more common in patients with Marfan syndrome, Ehlers–Danlos syndrome, and other connective tissue disorders. They are also associated with scoliosis and, in some patients, congenital heart conditions including mitral valve prolapse. These associations are assessed at consultation.
Pectus excavatum treatment
Surgical correction: the Nuss procedure
The Nuss procedure (minimally invasive repair of pectus excavatum, MIRPE) has transformed treatment since its introduction. It avoids the large incision and cartilage removal of older open techniques, achieving excellent results through two small lateral incisions.
Two small lateral incisions
A 2–3 cm incision is made on each side of the chest in the mid-axillary line. A thoracoscope (keyhole camera) is inserted to guide the entire procedure under direct vision. No large chest opening required.
Curved bar passed behind the sternum
A pre-shaped steel bar is threaded behind the sternum from one side to the other. The bar is precisely sized and contoured to each patient’s chest anatomy before the procedure begins.
Sternum elevated into its corrected position
The bar is flipped once in position, pushing the sternum forward. Stabilisers are attached to each end to hold the bar in place. The chest immediately takes on its corrected contour — the result is visible on the operating table.
Hospital stay and recovery at home
Most patients stay 3–5 days for pain management — the chest wall expansion is the main challenge in the first week. Return to light activity within 4–6 weeks; full activity including sport within 3 months.
Bar removed 2–3 years later — correction is permanent
Bar removal is a shorter, straightforward procedure under general anaesthetic. Once removed, the correction is permanent — the chest wall has remodelled into its new position. Long-term cosmetic and functional results are excellent in over 95% of patients.
The Ravitch procedure — an older open technique involving removal of the abnormal cartilage and repositioning of the sternum — remains appropriate for certain patients, particularly adults with rigid chest walls or significant asymmetry. Mr Scarci discusses the most appropriate approach at consultation based on your individual anatomy.
Recovery timeline after Nuss procedure
Nuss bar insertion under general anaesthetic. Keyhole surgery, no large incision.
Pain management and chest drain removal. Walking from day one.
Return to school or work. Light activity. No contact sports.
Return to sport. Bar remains in place for 2–3 years while cartilage remodels.
Pectus carinatum treatment
Bracing and surgical correction for protruding chest
Pectus carinatum rarely affects heart or lung function, but the cosmetic impact is real — and both non-surgical and surgical options are available.
Chest Wall Bracing
Custom-made compression braces apply controlled pressure to the protruding area, gradually reshaping the chest wall over time. Highly effective in children and adolescents whose chest walls are still flexible. Studies show excellent results with compliance.
- Typically worn 14–23 hours daily
- Noticeable improvement within 3–6 months
- Full correction often achieved within 12–24 months
- Designed to wear discreetly under clothing
- Success depends on compliance — wear as prescribed
Surgical Correction (Modified Ravitch)
Surgery is indicated for patients with severe deformities, those who have not responded adequately to bracing, or adults with rigid chest walls. The modified Ravitch procedure removes abnormal cartilage and repositions the sternum.
- Procedure typically takes 2–4 hours
- Hospital stay of 3–5 days
- Return to normal activity over 6–12 weeks
- Excellent cosmetic results with high patient satisfaction
- Appropriate when bracing is insufficient or chest wall is too rigid
When to consider treatment — functional and quality-of-life indications
There is no universal “right time.” The decision depends on severity, symptoms, age, and quality-of-life impact. A specialist assessment with proper imaging is the foundation of any treatment decision.
- Breathlessness or exercise intolerance disproportionate to fitness level
- Chest tightness or palpitations during activity
- Haller index ≥3.25 on CT scan (severe excavatum)
- Documented cardiac compression or heart displacement on imaging
- Reduced lung capacity or paradoxical chest movement
- Symptoms worsening progressively during puberty or adolescence
- Significant self-consciousness affecting daily life and activities
- Avoidance of swimming, sport, or situations requiring removing clothing
- Psychological impact — body image concerns, social withdrawal
- Pectus carinatum with noticeable protrusion causing embarrassment
- Patient motivation and realistic expectations about the outcome
- Quality-of-life impact is a legitimate surgical indication, not “just cosmetic”
Warning signs requiring prompt evaluation: Increasing shortness of breath, chest pain, heart palpitations, or progressive worsening of the deformity may indicate cardiopulmonary involvement. Do not wait for symptoms to become severe before seeking assessment.
Living with a chest wall deformity — the emotional and psychological impact is real.
The emotional impact of living with a chest wall deformity often equals or exceeds the physical challenges. Many patients experience anxiety, social withdrawal, or body image concerns — and these feelings are entirely valid. Your emotional well-being is as important as your physical health.
Adolescents and young adults
Peer acceptance, dating, sport, and social situations involving removing a shirt can all be affected. The fear of questions or judgment can lead to avoidance behaviours that limit experience. These concerns are valid — and treatable.
Adults seeking treatment
Many adults carry the impact of a chest wall deformity for decades before seeking help. Adults successfully undergo correction — age does not exclude surgery. The decision should balance lifestyle, career demands, and support availability.
Family support
For younger patients, open communication and family involvement in treatment decisions are important. Validating a child’s concerns without minimising them is the foundation of a good treatment experience. Siblings may also need support and information.
Insurance coverage and financial considerations
Insurance coverage for chest wall surgery has become more complex. Understanding what is typically covered — and what documentation is required — helps avoid delays.
- Documented cardiopulmonary impairment (breathlessness, reduced function)
- Haller index ≥3.25 on CT for pectus excavatum
- Cardiac compression confirmed on echocardiogram
- Reduced pulmonary function on formal spirometry
- Exercise intolerance documented on cardiopulmonary exercise test
- CT scan with Haller index calculated
- Pulmonary function tests (spirometry)
- Cardiac assessment — ECG and echocardiogram where indicated
- Physical examination and consultant letter
- Cardiopulmonary exercise test for exercise intolerance claims
Mr Scarci’s team handles pre-authorisation with your insurer. If you are self-funding, a transparent cost estimate is provided before any commitment. NHS funding is available in some cases — the team can advise on the individual funding request pathway where relevant.
“Marco Scarci is renowned for his expertise in thoracic surgery. Patients consistently highlight his compassionate approach, clear communication, and exceptional skill in delivering personalised treatment plans. Many praise his ability to put them at ease during challenging times and commend the successful outcomes of their surgeries. His dedication to patient care and cutting-edge techniques has earned him glowing reviews and deep gratitude from those he’s helped.”
Chest wall deformities — your questions answered
The most common is pectus excavatum (funnel chest) where the anterior chest sinks inward. It affects nearly two-thirds of all patients with chest wall deformities and is more prevalent in males. Pectus carinatum (pigeon chest) involves the breastbone protruding forward and accounts for most of the remaining cases. There is also pectus arcuatum — a rare variant that is a combination of the two, where the chest both sinks and protrudes. This is frequently misdiagnosed as pectus excavatum, which leads to the wrong treatment. Mixed and complex deformities exist and require individualised assessment.
Symptoms vary greatly with type and severity. Some patients with mild conditions have no physical symptoms at all. Those with more severe deformities can experience shortness of breath and pain along the anterior rib cage, especially after exercise. Breathlessness is common but difficult to assess at rest — most patients are young and fit when sedentary; problems emerge during submaximal exercise. In these patients a cardiopulmonary exercise test (CPET) is the most accurate way to document symptoms objectively. Static lung function tests and standard chest X-rays are often normal and are not reliable indicators of severity.
No. The Nuss procedure is performed in adults across a wide age range. Older adults experience more pain in the post-operative period because chest wall cartilage is less flexible, and recovery may be somewhat longer — but the procedure is entirely feasible and results are good. Adults in their 30s and 40s are successfully treated. Age alone is not a contraindication. A CT scan and pre-operative assessment will confirm suitability.
The functional impact of pectus excavatum is frequently underestimated in primary care. A Haller index ≥3.25 on CT, documented cardiac displacement, or reduced exercise tolerance on formal testing are objective functional criteria — not cosmetic. Even where measured function is normal, the psychological and quality-of-life impact is significant and is a legitimate surgical indication. A specialist assessment with proper imaging will clarify which applies to your case.
The Nuss procedure is minimally invasive — two small lateral incisions, no cartilage removal, a curved bar inserted behind the sternum and flipped to push it forward. The bar remains in place for 2–3 years while the chest wall remodels, then is removed under a short general anaesthetic. The Ravitch procedure is an older open technique involving removal of abnormal cartilage and repositioning of the sternum through a larger incision. It is still appropriate for certain patients — particularly adults with rigid chest walls or complex asymmetric deformities. Mr Scarci will recommend the most appropriate approach based on your anatomy and age.
The Nuss procedure leaves two small scars on the lateral chest wall, typically 2–3 cm each. These are positioned in the natural shadow under the arm and fade significantly over 12–18 months. Open Ravitch-type procedures leave more extensive scarring. Mr Scarci uses minimally invasive approaches wherever possible.
NHS funding for pectus surgery in adults is subject to individual funding request (IFR) processes and varies by ICB. Surgery is more commonly funded for cases with documented functional impairment (cardiac compression, reduced exercise tolerance on formal testing). Many patients choose to self-fund or use private health insurance to avoid the IFR process. Mr Scarci’s team can advise on the private pathway and provide documentation to support an NHS funding application where relevant.
You don’t have to live with this.
A consultation with Mr Scarci gives you a clear assessment of your condition, objective information about severity, and honest advice on what surgery can achieve — with no obligation to proceed.
