PE is thought to result from an abnormal overgrowth of cartilage adjacent to the sternum which displaces the sternum posteriorly. Most appear to be idiopathic in origin and 37% have a familial inheritance. The deformity wile diagnosed at birth may become more pronounced during adolescent growth.
Two surgical procedures are commonly utilized; the Ravitch surgical approach removes the abnormal cartilage preserving the perichondrium to allow for normal cartilage regrowth, and the Nuss procedure which is a minimally invasive technique involving internal bracing without cartilage resection.