Pectus excavatum occurs in approximately 1 in 400 live births.  The defect becomes progressively worse with growth and in the teenage years can become disabling.  Although considered cosmetic, and it is most certainly cosmetic, there are also well documented physiological changes such as decreased effort tolerance and cardiac arrhythmias.  The  young patients become used to the disability and are not really aware of any physiologic abnormalities until after the defect is repaired. For a good discription click here.

 The standard repair is the open or Ravitch operation which was first described in 1950 and has become the standard.  This procedure involves resecting multiple cartilages on each side of the sternum and splitting the sternum longitudinally to place it in the new position.  A new procedure was described by Nuss 16 years ago and is  a minimally invasive procedure which involves placing a steel bar behind the sternum pushing the sternum into the new position.  This is a much more cosmetic procedure involving small lateral incisions.  Especially in young girls this is a more preferable operation. The results from many centers are excellent and compared very favorably with the older Ravitch procedure.
There are two main approaches to repair of the defect. Click here for more information.
The Nuss operation is a minimally invasive procedure which was discribed by a Cape Town graduate Dr Nuss 16 years ago. It is a much quicker operation which gives considerably good results. Paper from Iceland click here. The operation is well discribed in this article(click here). For a  good article click here. And here

The Nuss procedure is now being performed in South Africa. For more information contact a Thoracic Surgeon.