Pectus Excavatum in Women and Girls: Breasts and Symptoms

Boys and men are referred for pectus excavatum three to five times as often as girls and women. You’d assume women rarely have it. But when researchers measured the chest CT scans of about 2,700 adults in the Dallas Heart Study, they found it slightly more often in the women (0.5%) than in the men (0.3%), as Biavati and colleagues reported in 2020.

So the gap may be less about who has a sunken chest and more about who gets noticed. If yours was spotted late, or waved off as cosmetic, that pattern is in the research too. Below: why pectus excavatum (PE) is easy to miss on a female chest, what it does to breasts, symptoms, pregnancy, what’s different for girls, and what each option changes.

A word on who’s writing. I had pectus excavatum, diagnosed 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, and I’m a man, so none of this is my experience of a female chest. It’s the published research on women and girls, with each number tied to the people it was measured in.

If your breastbone sticks out rather than sinking in, that’s a different condition. It’s covered in pectus carinatum in women.

Why pectus excavatum is often found late in women

Pectus excavatum is a breastbone that grows inward and leaves a dip in the front of the chest. Cleveland Clinic puts it at about 1 to 8 in every 1,000 people and says it happens more often in boys.

Why would women be missed? The Dallas authors suggest breast development and modesty may hide the dip, a hypothesis rather than a proven fact. Surgeons at Mayo Clinic Arizona, one large US centre, make a similar point in a 2024 survey of 432 adults evaluated there for surgery: breast tissue can hide the deformity and how severe it is, which makes diagnosis harder in women.

One disclosure, because several studies below come from that centre. Dr Dawn Jaroszewski is an author of every Mayo Clinic Arizona study on this page, and in the 2024 survey she reports consulting and royalty rights with Zimmer Biomet, which makes the Nuss bars her centre uses.

Women there also arrived later. Of 776 adults repaired at the centre between 2010 and 2019, 30% were women. They were older when they came in (mean age 35 against 32 for the men) and had a Haller index of 5.9 against 4.3. The Haller index compares chest width with the distance from breastbone to spine on a scan. Higher usually means deeper, though the Dallas study found women’s scores run higher than men’s in the general population too, so not all of that gap is depth.

A radiologist may spot a clue. On an ordinary front chest X-ray, women with PE tend to have sharper, more upright inner breast edges. A 2019 radiology study of 185 women with PE and 50 without named this the medial breast margin sign. It showed up in only 48% of the women with PE, but in just 4% of those without. So it’s a useful flag when present, and its absence doesn’t rule PE out.

What pectus excavatum does to your breasts

Your breasts sit on your chest wall, so when the middle sinks, they follow it. Three small studies of women seen at surgical or imaging clinics put numbers on that.

Study	Who was measured	What they found
Yoo 2023, Korea	22 young women (mean age 16.5) having a modified Nuss repair	The breasts slanted toward the middle. The distance between the nipples rose from 145 mm to 172 mm after the chest was repaired, with no breast surgery
Rha 2016, Korea	13 women with PE and 13 without, breast volume measured on CT	Left and right breasts were similar in size (209 and 218 mL), but both were much smaller than in the women without PE (415 and 439 mL)
Ma 2015, US	47 women who had their chest repaired at Mayo Clinic Arizona	Breast appearance was a concern for nearly half of them

In Yoo’s group, the slant came from the chest wall, not the breasts: the nipples moved apart once the breastbone was corrected. Breasts that look uneven may also owe more to the chest wall than to a real size difference. In Rha’s CT study the two sides held about the same volume, and the authors suggest correcting the skeleton for asymmetry first, then augmentation if the breasts are small. Thirteen women is a tiny sample, so treat that as a clue, not a rule.

One Korean surgical team goes further and writes that most women with asymmetric (lopsided) PE have underdeveloped breasts. That’s their impression from the women they operated on, not a count across everyone with PE.

If the daily problem is a bra that won’t sit right, the fit checks are in bras for pectus excavatum.

Symptoms, and being taken seriously

When PE causes symptoms, Cleveland Clinic lists breathlessness during exercise, chest pain, palpitations and an irregular heartbeat (more in pectus excavatum symptoms). What matters here is how differently women and men report them.

In the Mayo survey of 432 adults (58% men), women reported more limitation on all seven exercise questions and more often reported five of the six heart-related symptoms. Three in four respondents felt dismissed by their doctors, and women were more likely to. It’s a survey of people being evaluated for surgery, with no comparison group, so it describes them, not every woman with a dip.

Yet women often test better. Among the 776 repaired adults at the same centre, women scored higher on the cardiopulmonary exercise test, where you cycle or run while your breathing and heart are measured. And at Cincinnati Children’s, among 345 children and teens evaluated before surgery (mean age 15, 19% girls), the girls had deeper chests than the boys but better results on heart scans, lung tests and exercise tests.

The Cincinnati authors say the reason still needs research. My reading, an interpretation of people referred for surgery rather than a measured finding: in women, how deep the dip is, how you feel and how your heart and lungs test can all point different ways. That’s an argument for getting symptoms tested.

Know which test answers which question. A CT scan, or sometimes an X-ray, shows how deep the chest is, not how the heart and lungs work. Those are checked with an echocardiogram (an ultrasound of the heart) or cardiac MRI, lung function tests and an exercise test. If you were told your PE is “just cosmetic” without any of those, it’s fair to ask how that was decided.

When to see a doctor first

See a doctor before you start any device 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

Pregnancy and breastfeeding

The evidence here is thin, and I’d rather say so than fill the gap with reassurance.

• Breathing late in pregnancy. In one surgeon’s series of female patients repaired over 33 years, nine women with PE had a successful pregnancy before their repair, and all nine had severe breathlessness in the last three months. These were women who later needed surgery, and the series doesn’t count women with PE who had easy pregnancies, so it doesn’t show PE makes pregnancy dangerous. It does make breathing worth raising early if you already have symptoms.
• Pregnancy with a Nuss bar in place. Three case reports, from 2011, 2015 and 2024, describe five women in total who gave birth with the bar still in place, one of them to twins. The authors of the most recent report call the data limited and say women may need advice on whether to put off the repair or the pregnancy.
• Breastfeeding. I found no peer-reviewed evidence either way. Some clinic and implant-maker pages say PE doesn’t stop breastfeeding, but the ones I read don’t cite a study. Not studied isn’t the same as no effect, or as a problem.

If you’re pregnant or planning to be, tell your obstetric team about your chest. The product page for my own vacuum bell asks you to speak to your doctor before using it if you’re pregnant or have had chest, heart or breast surgery in the last six months. More in pectus excavatum and pregnancy.

Girls: breasts, growth spurts and timing

PE often progresses slowly through childhood and then deepens quickly at puberty, which is why so many people first notice it as teenagers. For girls, those are the same years the breasts develop. No study I found measured the two together, so the overlap is my reading: the chest can change shape just as breast tissue starts to cover it.

It shows up in the bell research. In an Amsterdam series of under-18s treated with a vacuum bell between 2008 and 2021, 11 of the 28 girls (39%) stopped because their breasts were growing. For girls, the authors prefer either watchful waiting or starting the bell early, before breast growth gets in the way.

Women’s bells exist. Eckart Klobe, who designed the original bell, makes a 19 cm women’s type curved in at the sides to take pressure off the breasts. He says it usually suits bra cups A and B, sometimes C (German sizing), and his Spanish distributor Ventura lists cups A to C. Klobe names irritated nipples as the most annoying side effect, mainly during puberty. Makers and sizes are compared in vacuum bell sizing. For younger children, see vacuum bell therapy for kids.

I haven’t found a source that sets one right age for surgery in girls, so timing is a conversation for her and a surgeon.

Your options, by what each one changes

The useful question isn’t which option is best. It’s what each one changes: the bone, the look, or how your heart and lungs work.

Option	Moves the breastbone?	Changes the look?	Can help heart and lung symptoms?	Women-specific note
Posture and training	No	Can make the dip look less deep	Not shown	No women-specific study found
Vacuum bell	Can lift it in some cases	Yes, when it works	Not shown	No women-specific study found. 11 of 28 girls in one series stopped as their breasts grew
Breast implants	No	Yes	No	One centre’s 2026 study advises removing them before a chest repair
Custom chest implant	No	Yes, fills the dip	No	Fluid build-up (seroma) is usual, and a later breast operation is common
Nuss procedure	Yes	Yes	Improved equally in women and men at one US centre	Women needed three bars less often, but reported more pain after surgery
Ravitch procedure	Yes	Yes	Symptoms eased in one surgeon’s series of female patients	Can be done through cuts under the breasts

Vacuum bell

A vacuum bell is a suction cup worn over the dip to lift the breastbone gradually, over months. I couldn’t find any study of how well it works specifically in women. In a Boston Children’s Hospital series of 57 patients (86% male), sex didn’t predict how much the dip corrected, and hours of wear per week was the strongest predictor. So don’t rule a bell out because you’re female, but with so few women in the study, it isn’t proof it works as well for you. More in vacuum bell therapy.

Nuss and Ravitch in women

The Nuss procedure slides curved metal bars under the breastbone through small cuts at the sides of the chest to push it forward. The bars come out in a later operation. The Ravitch is an open operation that reshapes the rib cartilage and repositions the breastbone.

• Nuss at Mayo Clinic Arizona. In 609 adults, women needed three bars less often than men (12% against 42%), with no significant difference in hospital stay or complications. Women reported more daily pain afterwards but used more opioids only on day one. In 142 patients retested at bar removal, the heart and lung benefit was equal in women and men.
• Nuss in Taiwan. Of 126 adults who had a Nuss between 2005 and 2007, 15 were women (mean age 25, Haller index 5.72). Seven needed two bars, and the authors report high satisfaction and acceptable complications.
• Ravitch through cuts under the breasts. An Istanbul team has repaired 12 female patients since 1991 through two 4 to 5 cm inframammary incisions, cuts in the fold under each breast that hide the scar. Correction was satisfactory in all 12, with one seroma (a pocket of fluid under the skin), one pneumothorax (air around a lung) and no recurrence over 3 months to 9 years. Breast development and sensitivity were normal.
• Ravitch over 33 years. In the pregnancy series above, one surgeon repaired 104 female patients with PE and 21 whose breastbone stuck out. 96% reported very good to excellent results after a mean of six years, symptoms eased within six months, and none had significant breast asymmetry afterwards. It’s one surgeon’s work, some of it decades old.

Cost, recovery and risks are in my pectus excavatum surgery guide.

Implants and breast surgery

Implants change the look, not the bone. The surgeon behind the 33-year series put it plainly: prostheses don’t help the heart and lung symptoms.

• Breast implants add volume and can soften how the dip looks. In a 2024 private-practice series, 28 women with PE had augmentation to enlarge their breasts, even out asymmetry and improve the chest’s look, with no complications and better quality-of-life scores. That’s cosmetic surgery, and it says nothing about breathing.
• A custom chest implant is a silicone piece shaped to your dip and placed under the chest muscles. Seroma is the usual problem: the Toulouse team that developed it reported one around the implant in all 401 cases. In the same team’s series of 301 women, mostly with PE, a second breast operation was common, especially with little breast tissue. One author of that series works for the implant’s maker.

Which comes first? Three of the teams above (Taiwan, the Korean CT study and Toulouse) put the chest first and the breasts later. That’s common advice, but the other Korean team above did both in one operation. And if you already have breast implants, one centre’s own advice has changed:

• 2015: in 47 women repaired at Mayo Clinic Arizona between 2010 and 2013, 32% had had breast or chest implants before. Complications and stay didn’t differ with earlier or same-day breast surgery, and the authors recommended doing both at once.
• 2026: in 456 women repaired at the same centre between 2010 and 2025, 22.8% had breast implants. With implants present at the repair, infection within 12 months was 8.8% against 1.8% without them, and pneumothorax and haematoma (a collection of blood) were more common in the first 30 days. The authors now recommend removing implants before the repair and replacing them later if you want.

The newer study is nearly ten times larger, so I’d give it more weight, though both look back through one centre’s records. Ask your surgeon which approach they use and why. More on plastic surgery and implants for pectus.

Confidence and how you see your chest

It’s easy to assume women take PE harder than men. On one measure the Mayo survey found the opposite: the look of the deformity hit the men harder. That doesn’t mean women mind less overall.

A small Innsbruck study had 18 women (mean age 20) whose chests had been repaired rate before-and-after photos of themselves, alongside a panel of 24 medical professionals and students. Before surgery, the women rated their own chests as worse than the panel did. After, the two ratings were much better and very similar, and the women’s well-being had clearly improved.

How your chest looks to you and to others can be far apart, and your view still counts. While you decide, how to hide pectus excavatum covers tops and swimwear. If it’s weighing on your mood, see the psychological side of pectus excavatum. And the only famous woman I could confirm has talked about hers is Tori Spelling, in celebrities with pectus excavatum.

Where to start

If anything on the red-flag list fits you, see a doctor first, and ask for the heart and lung tests, not just a look at the dip. If you’re pregnant, start with your obstetric team.

Otherwise, find out where you stand. My free 1-minute quiz gives you a sense of how deep your chest is and which non-surgical route fits your case. Then expect an honest timeline. Structural change is measured in months and years. Mine took about three years of daily work, and the result was visible and measurable, but not complete.

Sources

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