Pectus carinatum, often called “pigeon chest,” is a common chest wall deformity characterized by an outward protrusion of the sternum (breastbone) and adjacent ribs. It occurs in approximately 1 in 1,000 to 1,500 live births. This condition affects a person’s physical appearance and sometimes their function, leading many to wonder if it will correct itself over time.
Defining Pectus Carinatum
Pectus carinatum originates from an overgrowth or abnormality in the costal cartilage, which connects the ribs to the sternum. This excessive growth pushes the sternum forward, creating the characteristic bowed contour of the chest. While the exact cause is often unknown, it is associated with rapid skeletal growth during adolescence. Roughly 25% of patients have a family history of a chest wall abnormality, indicating a genetic component.
The condition typically becomes more noticeable around age 11 or later, coinciding with pubertal changes. It is classified into two main types based on the location of the protrusion. The most common form (over 90% of cases) is chondrogladiolar prominence, affecting the middle and lower parts of the breastbone. The rarer type is chondromanubrial prominence, where the upper sternum is affected.
Why Pectus Carinatum Does Not Resolve
The definitive answer is that Pectus carinatum does not resolve naturally. It is a structural, skeletal deformity involving the bone and cartilage framework of the rib cage. The underlying issue is an overgrowth of cartilage that physically pushes the sternum outward, resulting in a permanent change to the chest wall structure.
The deformity tends to become more pronounced, not less, during periods of rapid growth, such as adolescence. As the bones and cartilage grow, the imbalance causing the protrusion is often amplified. Spontaneous correction of this established skeletal anomaly is highly improbable once the growth spurt has begun.
The chest wall becomes less flexible as an individual reaches skeletal maturity, meaning the cartilage hardens and fixes the protrusion in place. This lack of natural reversibility is why intervention is required for correction. Treating the condition relies on actively reshaping the chest wall while it still retains some malleability, usually before the end of the teenage years.
Treatment Options for Correction
Since the condition does not self-correct, treatment focuses on physically correcting the protrusion, with options ranging from non-surgical to surgical methods. Non-surgical treatment is the preferred approach for most patients, especially those who are still growing and have a flexible chest wall. This method involves external dynamic compression bracing, which functions much like orthodontic braces for teeth.
A custom-fit brace applies continuous, gentle pressure to the sternal protrusion, gradually pushing the breastbone back into a normal position over time. Brace therapy is most effective when the patient is young and compliant, typically worn for 8 to 12 hours a day for a period that can range from six months up to two years. The success of non-surgical bracing is highly dependent on the flexibility of the patient’s chest and consistent adherence to the wearing schedule.
Surgical intervention, such as the modified Ravitch procedure, is reserved for severe cases, patients who have completed skeletal growth, or those for whom bracing has failed. This open procedure involves removing the abnormal, overgrown costal cartilage causing the protrusion. The sternum is then repositioned and sometimes stabilized with internal supports, allowing the chest wall to heal in the corrected position.
Physical and Psychological Impacts
Although Pectus Carinatum is usually not life-threatening, the physical and psychological consequences often motivate patients to seek correction. Physical symptoms are typically mild, but they can include chest pain and tenderness at the site of the protrusion. Some individuals experience shortness of breath during vigorous physical exertion, which may lead to exercise intolerance or fatigue.
The psychological impact of the condition is often the most significant factor, especially during the self-conscious years of adolescence. The highly visible nature of the protrusion can lead to issues with body image, reduced self-esteem, and social anxiety. Many patients report that cosmetic reasons are the primary motivation for seeking treatment, as successful correction can significantly improve their mental quality of life and confidence.