A 14-year-old soccer player who suddenly cannot keep up with his teammates may be living with more than a growth spurt. In a recent medical Q&A published on October 24, 2026, mlive featured guidance from Mayo Clinic pediatric surgeon D. Dean Potter Jr. on pectus excavatum, a chest-wall condition that often becomes more pronounced during puberty and can genuinely limit a teenager's breathing, endurance, and confidence.
The column came in response to a parent whose son was diagnosed with the condition after struggling with shortness of breath and early fatigue during his fall soccer season. It is a scenario that plays out in thousands of families each year, often with too little information and too much anxiety. Here is what the medical evidence says, and what parents and young athletes should understand before making treatment decisions.
What is pectus excavatum?
Pectus excavatum is a deformity in which the breastbone, the sternum, sinks into the chest. According to the Mayo Clinic advice published by mlive, the condition is often noticeable shortly after birth, but it typically worsens during the rapid growth of puberty, which is exactly when many teens push their bodies hardest in sports.
, pulling the sternum inward. The result is a visible dip in the center of the chest that ranges from mild to severe.
For some children, the sunken chest is mainly a cosmetic issue. For others, especially those with a deeper depression, the sternum can compress the heart and lungs and interfere with how well they work. Dr. Potter noted that symptoms can include shortness of breath, chest pain, fatigue, a rapid or pounding heartbeat, and reduced endurance during exercise.
When does a sunken chest actually affect performance?
A teenager who suddenly tires faster on the field deserves a real medical workup, not a shrug. But Dr. Potter was careful on this point: shortness of breath during exercise has many possible causes, and families should confirm that pectus excavatum is actually responsible before assuming it is.
The evaluation usually starts with a physical exam. From there, doctors may order a chest X-ray or other imaging, an electrocardiogram, an echocardiogram, lung function tests, or an exercise test. The goal is twofold: measure how severe the deformity is, and determine whether the heart or lungs are being affected.
Not every teen with pectus excavatum needs surgery
This is the part of the medical guidance that families most need to hear. Many children and teens with the condition never go under the knife, and treatment decisions rest on symptoms, the degree of chest-wall deformity, and whether heart or lung function is compromised.
For mild cases, physical therapy can improve posture and increase how much the chest expands. For children and younger teens, there is also a nonsurgical option called sternal suction, or vacuum bell therapy. A cup-shaped device is placed over the breastbone and uses suction to gently pull it forward. The catch is commitment: the device has to be used regularly over many months to produce results.
How the Nuss procedure works
When symptoms are moderate to severe, surgery enters the conversation. The most common operation is the Nuss procedure, a minimally invasive technique that has largely replaced older, more invasive approaches.
The surgeon makes small incisions on each side of the chest and, guided by a tiny camera, places a curved metal bar underneath the breastbone. The bar is then rotated, lifting the sternum into a more typical position. Some patients need more than one bar. The bar stays in place for two to three years while the chest remodels itself, and is then removed in a second procedure.
Recovery has changed, and opioids are no longer the default
One of the most notable parts of the Mayo Clinic guidance concerns pain management, an issue that matters in a country still grappling with the aftermath of an opioid crisis driven in part by overprescription after surgery.
Mayo Clinic uses cryoablation during the operation, a technique that temporarily freezes the nerves in the chest wall that transmit pain. The numbing effect can last for weeks while the chest heals. Dr. Potter said the approach has significantly changed recovery and reduced the need for opioid pain medication. Many patients at Mayo Clinic walk the day of surgery and go home the following day.
For communities working to keep opioid exposure low, especially among young patients, that shift is worth noticing. It shows what postoperative care can look like when pain control is designed deliberately rather than defaulted to a prescription pad.
After surgery, teens still need time to heal before returning to strenuous activity. The surgical team provides specific guidance on activity restrictions and when a safe return to soccer or other sports is realistic.
The part of the conversation that is not physical
Dr. Potter raised a point that extends well beyond the operating room. Adolescence is a time when young people are often deeply self-conscious about their appearance, and a visible difference in chest-wall shape can affect body image and self-esteem.
That is not a minor footnote. Teens with visible physical differences frequently withdraw from sports, swimming, and social situations long before any doctor raises the question of surgery. Parents and healthcare teams should treat those concerns as legitimate parts of the medical conversation, not as vanity to be dismissed.
Why this matters beyond one family
Health questions like this one land at the intersection of access and awareness. A teen with unexplained shortness of breath needs a thorough evaluation, including imaging and cardiac testing, and families without adequate insurance or a pediatric specialist nearby often face barriers to exactly that kind of workup. The gap between what medicine can do for pectus excavatum today and what many families can actually reach is part of the broader story of American healthcare inequality.
The medical facts, though, are encouraging. As the mlive column and both make clear, many children and teens with pectus excavatum never need surgery, and those who do have access to a minimally invasive procedure with a far gentler recovery than past generations endured.
Frequently asked questions about pectus excavatum in teens
Does pectus excavatum always require surgery?
No. According to Mayo Clinic pediatric surgeon D. Dean Potter Jr., many children and teens with the condition do not need surgery. Mild cases may respond to physical therapy or vacuum bell therapy, while surgery is generally reserved for moderate to severe symptoms.
What are the symptoms of pectus excavatum in teenagers?
Symptoms can include shortness of breath, chest pain, fatigue, a rapid or pounding heartbeat, and decreased endurance during physical activity. The condition often becomes more pronounced during pubertal growth.
How long does recovery from the Nuss procedure take?
Many patients walk the day of surgery and go home the next day. The metal bar remains in place for two to three years while the chest remodels, after which it is removed. Return to sports depends on the surgical team's specific instructions.
Can pectus excavatum affect a teenager's mental health?
Yes. Dr. Potter noted that a noticeable difference in chest-wall shape can affect body image and self-esteem during adolescence, and those concerns should be discussed openly with the child's healthcare team.