Background. Surgical correction of pectus deformities was mainly perfo
rmed for cosmetic and psychologic reasons but eventual cardiopulmonary
symptoms improved. Whether this results from alterations in cardiopul
monary physiology is still controversial. Methods. In 25 years 662 pat
ients underwent correction (390 for pectus excavatum-funnel chest, 235
for pectus carinatum-chicken chest, 37 for pectus arcuatum -pouter pi
geon chest). Surgical correction was mainly performed for cosmetic and
psychologic reasons. Sternochondroplasty was performed without prosth
etic material. Results. Clinical results for funnel chest were satisfa
ctory in 83.6% (excellent 44.1%, good 39.5%) and were always good for
protrusion deformities if enough deformed cartilages were resected. In
a retrospective study the pulmonary function tests performed on 152 p
atients with funnel chest before surgery and at longterm follow-up dem
onstrated an eventual increased restriction at follow-up, despite symp
tomatic improvement and increased anteroposterior chest diameter on th
e X-ray, but restricted anterior chest wall motion. In a prospective s
tudy the exercise cardiorespiratory function tests on 35 patients with
funnel chest before and one year after operation suggested unchanged
work performance, but an increased oxygen consumption and acidificatio
n due to a higher work of breathing after operation, caused by decreas
ed chest wall compliance. Conclusions. The subjective physical improve
ment after operation cannot be explained by changes in static lung vol
umes or in cardiorespiratory function at exercise, but is due to other
unexplained factors. Satisfactory subjective long-term results of mos
t patients justify surgical correction. Both physical as well as psych
ologic and cosmetic factors may allow operative correction.