Pectus Excavatum Pain: Chest, Back and After Surgery

Your chest aches. Maybe it’s under the breastbone, maybe along the ribs, maybe only when you sneeze or climb stairs. Under the question of whether your pectus is to blame sits a quieter one: is this my heart?

Chest pain is commonly reported by people with pectus excavatum who see a surgeon. But how deep the chest is barely predicts it, nobody has proven where the pain comes from, and every figure comes from people referred for or having surgery, not from everyone with pectus. So chest pain gets checked by a doctor before anyone pins it on your chest.

Worried right now? Skip to when to see a doctor.

I was diagnosed with pectus excavatum at 15 and corrected it without surgery over about three years. The change was visible and measurable, but not complete. I’m not a doctor, so every medical point below comes from a named study or hospital, and where nobody has studied something, I say so.

Can pectus excavatum cause chest pain?

Pectus excavatum can come with chest pain, and it’s commonly reported by people who see a surgeon for it. Whether the pectus itself causes the pain hasn’t been proven, and the numbers depend on who was asked and how.

Who was studied	How	Chest pain
432 adults evaluated for surgery, Mayo Clinic Arizona, 2020 to 2021	Symptom survey	88%
320 adults repaired at UCLA, 1986 to 2007	Look back through surgical records	69%
116 adults repaired at UCLA	Look back through surgical records	84 of 116 (about 72%), with activity
329 people referred for surgical evaluation, Cincinnati Children’s, 2015 to 2018	Look back through records	Adults 57%, teens 38%
77 adults repaired at Emory, 1971 to 2001	Look back through surgical records	8 of 77 (about 10%)
375 surgical patients at UCLA, 1969 to 1999	Look back through surgical records	8%

Every row is a referral or surgical group: people sent to a surgeon, who skew toward deep, symptomatic chests. I couldn’t find a figure for people with pectus in general. The gap between 8% and 88% says more about how each study asked than about your odds.

The biggest of these, the Mayo Arizona survey, had no comparison group, and its median Haller index was 4.2. That’s a severity number from a chest scan, where about 2.5 is average. Its first author discloses royalties from the maker of the Nuss bar.

Depth barely predicts it. In that Mayo Arizona group, the total symptom score tracked the Haller index only weakly, at r = 0.16, where 0 means no relationship and 1 a perfect one. That score covers all symptoms, not chest pain alone. My takeaway: a deep chest doesn’t mean pain, and a mild one can still hurt.

Who reports more. In the Cincinnati referral group, adults reported chest pain more often than teenagers, and also had deeper chests. Among 776 adults repaired at Mayo Clinic Arizona, women arrived more symptomatic and reported more daily pain after surgery. In a global health-records database of 2,843 Nuss patients, chronic pain was recorded within 90 days of surgery in 5.2% of females against 2% of males. Those figures come from codes in medical records; nobody scored the pain.

Why it hurts: what’s known and what isn’t

Nobody knows for sure. I couldn’t find a study that establishes whether pectus chest pain comes from the heart, the cartilage, the muscles or posture. There are three leading ideas.

• The chest wall itself. The Mayo Arizona authors write that costochondritis, inflamed cartilage where the ribs join the breastbone, and muscle pain from the chest’s altered mechanics “are thought to be the cause”. They add that some pain patterns mimic a heart attack, but none has been tied to ischemia, the heart muscle being starved of blood.
• Muscles and posture. MUSC Children’s Health says many patients have chest wall or back pain that is musculoskeletal, with a cause that isn’t well known but may be partly related to poor posture.
• Pressure on the heart. Mayo Clinic lists chest pain or pressure among the effects when a severe dip squeezes the heart. That compression is documented in severe chests, as I explain in pectus excavatum and heart problems. That it causes the pain hasn’t been shown.

Children’s Mercy Kansas City says some symptoms may get worse with physical activity, but the activity itself doesn’t pose a health risk. That’s reassuring once a doctor has checked you, because the NHS lists exercise as a common trigger for angina, chest pain from the heart.

Is it your pectus or something else?

Having pectus doesn’t protect you from other causes of chest pain. In one case report, a 23-year-old with a severe sunken chest and chest pain turned out to have a 10 cm aortic aneurysm, a swelling of the main artery leaving the heart, plus a badly leaking valve. Surgeons repaired the aorta and left the chest alone. That case and the other red flags are in my guide to pectus excavatum symptoms.

A sore spot you can press doesn’t settle it either. Chest-wall pain is often tender to touch, yet a 2021 review in American Family Physician cites a study in which 12% of emergency department patients with chest pain and chest-wall tenderness were having a heart attack. One study, but enough to keep “it hurts when I press it” from being the all-clear.

Breastbone pain, popping and costochondritis in general have their own guide: sternum pain and popping.

Back and rib pain

I couldn’t find a study that measured how often people with pectus have back pain. MUSC’s view above covers back pain too. My pectus posture guide has a routine, but I couldn’t find a study showing posture work relieves pectus back pain.

Is it scoliosis? Less often than you may have read. In a 2024 study of 418 people with pectus excavatum seen at a chest wall clinic in Istanbul, co-authored by Prof. Yüksel, 57 (13%) had a spinal deformity, most often scoliosis, a sideways curve of the spine. That’s one clinic group, and the abstract reports nothing on pain.

After surgery, a 2023 review by the Mayo Clinic Arizona team says back spasms and pain are common and ease significantly over several weeks.

Without surgery, the NHS back pain advice is a fair guide, though it isn’t written for pectus. Stay active, and see a GP if the pain isn’t better after a few weeks, is worse at night, is worse when you sneeze or cough, or comes from between the shoulders.

Rib pain. If the pain sits along your lower ribs, two things are worth reading about. Rib flare is where the bottom edge of the ribcage sticks out. Slipping rib syndrome is where a lower rib moves more than it should and catches on its neighbor. Clicking, catching or sharp pain at the lower rib tips, worse with coughing, laughing or leaning, can point to it. Both are in my flared ribs guide, including when to get assessed.

Pain when you sneeze, laugh or cough

Start with the weeks after surgery. Coughing after a Nuss is painful enough that hospitals teach a way through it. SickKids in Toronto asks patients, every waking hour after their breathing-trainer exercises, to take a deep breath and cough two or three times while hugging a pillow against the chest. SickKids doesn’t mention sneezing or laughing. My suggestion: try the same pillow hug when you feel a sneeze or a laugh coming.

Without surgery, I found no pectus-specific study of pain with sneezing, laughing or coughing. Chest-wall pain in general behaves this way, though. Costochondritis tends to hurt more with deep breaths and coughing, Tietze syndrome (swelling of the same rib cartilage) with sneezing and coughing, and slipping rib with coughing and laughing. Back pain that gets worse when you sneeze or cough is one of the NHS reasons to see a GP.

Does the weather make it worse?

I found no pectus-specific study of weather and pain, including after the Nuss. The best general evidence, on joint and back pain, says weather probably isn’t a big driver. A 2024 meta-analysis of 11 studies found no link between humidity, air pressure, temperature or rain and flares of low back pain, knee pain or rheumatoid arthritis. Gout was the exception.

One safety point. The NHS says angina attacks are often brought on by exercise, stress, emotion or cold temperatures. New chest tightness in the cold, especially with effort, is a question for a doctor, not the weather forecast.

Pain with a vacuum bell or brace

Some soreness at the start is common with the bell. In Basel’s 140 bell patients, most had moderate pain in the breastbone during the first five applications, without needing painkillers. Two rules from the bell’s maker and hospital instruction sheets, explained in vacuum bell therapy:

• Pain means stop pumping. Don’t increase the suction once it hurts.
• Back pain or burning, prickly arms mean take it off. Try again later at lower pressure.

Compression braces can hurt too. In Dr. Haje’s series, discomfort or brief pain came up in 15% of 115 patients with the localized type and 12% of 84 with the broad type, and eased when the pressure was lowered. More in pectus excavatum braces.

My rule for any bell or brace: if pain starts with it, or lasts after it’s off, stop and consult a healthcare professional. If you had chest pain before you started, see a doctor before you start at all.

Pain after the Nuss or Ravitch

Pain after pectus surgery is expected, and for most people it fades over weeks to months. Pain plans, cryoablation trials and the week-by-week recovery table are in my Nuss procedure guide.

How long it usually lasts

• Across 11 centers. In 327 patients at 11 North American centers, 284 with the Nuss and 43 with open repair, median pain was 3 out of 10 at discharge and 1 out of 10 by 30 days.
• One surgeon in Istanbul. In 207 Nuss patients reached by phone, pain lasted about 52 days on average. The study was co-authored by Prof. Yüksel.
• With cryoablation. Cryoablation freezes the nerves between the ribs during surgery to block pain. In a Children’s Mercy cryoablation group, where 48 of 110 patients answered a survey, 55% still had tolerable pain at 2 weeks and 41% at 3 months, and 25% were taking pain medicine on and off at 3 months.

When pain doesn’t settle

In 57 teenagers in Montreal, 18% had persistent pain a year after the Nuss, all of them with severe chests. Adults and women arrive with more symptoms, and women report more pain after surgery, as covered above.

Sometimes the cause is the bar. The Nuss developers fit it slightly loose because a too-tight bar can cause pain, and a bar that moves can show up as pain. New or worse pain after a knock, or with a change in your chest’s shape, means calling your surgeon. SickKids says to speak to your care team about significant pain that doesn’t improve over time.

The Ravitch. I couldn’t find a hospital pain or discharge protocol for the Ravitch. The 2024 Pectus Care Guidelines rate its pain as similar to the Nuss. More in the Ravitch procedure.

Bar removal is smaller. CHKD’s removal sheet says pain medicine may be needed for 2 to 5 days. More in pectus bar removal.

Numbness and the phantom feeling

After cryoablation, expect a numb chest for months. In 121 Cleveland Clinic patients, normal feeling returned after a median of 6 months, anywhere from 1 to 12, and in 98.3% by 12 months. In 47 young cryoablation patients in Phoenix checked at bar removal, a median of 2.9 years after surgery, 46.8% still had a small numb area.

What about feeling the old dip after repair, the “phantom” chest? I couldn’t find a study. The closest is a Children’s Mercy Kansas City survey of 153 people about 9.6 years after repair, only 26% of those asked: 30.7% sensed their chest moving inward, and 6 of those 47 asked to be checked again. My interpretation: a patch of numb skin can make a chest feel odd. If you think yours is sinking, measure it at home the same way each month and see your surgeon.

When to call your surgeon

Your hospital’s sheet comes first. Children’s Hospital of Philadelphia is a good example:

When to call. CHOP’s list: fever above 101.5 °F (38.6 °C), more redness or swelling at the cuts, any drainage, trouble breathing, a change in how the chest looks, new or worse chest pain, or any injury to the chest.

Children’s Mercy adds new pain that over-the-counter pain medicine doesn’t help.

Does treatment relieve the pain?

Surgery often does, though not for everyone. The vacuum bell hasn’t been shown to.

• Open repair, 116 adults at UCLA. Chest discomfort was reduced in 82 of the 84 who had it.
• Open repair, 320 adults at UCLA. All patients’ symptoms improved within four months. Surgeon-reported, and for symptoms overall, not chest pain alone.
• Open repair with a titanium plate. Of 37 patients who answered a survey, 59% said their chest pain improved. The abstract doesn’t say how many had chest pain to begin with.
• Vacuum bell. In 240 children in London, all early responders to the bell, 18 to 24 months of use lowered their breathing-difficulty score, but chest pain scores didn’t significantly change.

I couldn’t find an exercise, physio or posture trial that measured pain in pectus. So if someone promises a routine that ends pectus pain, ask for the study.

What helps in the meantime

Once a doctor has ruled out anything serious, general chest-wall and back-pain advice is a sensible start. It comes from the NHS back pain page and the costochondritis review above, and none of it has been tested in pectus.

• Keep moving. The NHS advises staying active rather than resting in bed.
• Heat or ice packs. Both are suggested for back pain, and heat for costochondritis.
• Pharmacy pain relief, if it’s suitable for you. Anti-inflammatories such as ibuprofen are in both sources. Ask a pharmacist if you’re unsure.
• Ease off what sets it off. Rest from the movement that brings the pain on.

Stretching and posture work can help your chest, shoulders and upper back move and feel better. They aren’t proven to relieve pectus pain. My pectus excavatum stretches follow one rule: tightness is fine, pain isn’t.

When to see a doctor

See a doctor before you start any device, brace or exercise program if any of these apply to you:

• chest pain
• fainting or nearly fainting
• breathlessness at rest or with light effort
• palpitations or an irregular heartbeat
• a diagnosed heart or lung condition
• Marfan syndrome or Ehlers-Danlos syndrome, or a doctor has raised either
• previous chest surgery
• a Haller index above 3.25 together with symptoms
• symptoms that nobody has checked yet

None of these means you’ll need surgery. They mean someone should look at your heart and lungs before you go further. An index above 3.25 is a common referral threshold, not an emergency.

Call 911 (999 in the UK) or your local emergency number now if you have any of these. Don’t drive yourself.

• palpitations that won’t stop
• palpitations with chest pain, shortness of breath, feeling faint or fainting
• sudden chest pain or pressure that doesn’t go away
• chest pain that spreads to your arm, neck, jaw or back
• chest pain with sweating, feeling sick, light-headedness or breathlessness

That list follows the NHS advice on chest pain and palpitations, as in my heart problems guide.

The NHS back pain advice treats back pain that comes with chest pain as an emergency too.

What to do next

Pick the line that sounds like you.

• Chest pain nobody has checked. See a doctor first, before any device or program. Use the 911 list above if it fits.
• Checked, and it’s chest-wall or back pain. Try the general care above, and see your doctor again if it changes or doesn’t settle.
• Pain with a bell or brace. Stop and consult a healthcare professional.
• Recovering from surgery. Expect weeks to months, keep your hospital’s call list close, and call about new or worse pain.
• Pain-free, or cleared by a doctor, and wondering about your chest. For a sense of how significant yours is and which route fits, take my free 1-minute quiz.

Whatever you pick, give it honest time. Pain after surgery is measured in weeks to months, and structural change without surgery in months and years.

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