Pectus carinatum is a chest wall deformity where the sternum and ribs protrude outward. This condition is sometimes called “pigeon chest” due to its bird-like appearance. While often a cosmetic concern, pectus carinatum can occasionally lead to physical symptoms such as chest pain or shortness of breath with exercise. Correction methods range from non-invasive approaches to surgical procedures.
Non-Invasive Correction Methods
Bracing stands as the primary non-invasive treatment for pectus carinatum, working by applying continuous pressure to the protruding chest wall to gradually reshape it. This method functions similarly to how orthodontic braces realign teeth, gently guiding the sternum back into a more typical position. The custom-made brace features padded plates and adjustable straps for targeted compression.
Adolescents with flexible chest walls are good candidates for bracing, as their growing bodies are more adaptable to reshaping. The effectiveness of bracing decreases once the chest bones are fully formed in adulthood. Treatment duration ranges from 6 months to 2 years, though some individuals may require longer periods. Consistent wear is important for successful outcomes, with recommendations suggesting 8 to 12 hours or more per day.
Success rates for bracing are high, with studies showing satisfactory chest appearance in a majority of compliant patients. Outcome factors include patient age, chest wall flexibility, and adherence to the wearing schedule. After the initial correction, a brace may be worn less frequently, similar to a dental retainer, to maintain the new shape until skeletal maturity is reached.
Surgical Interventions
For cases where bracing is not suitable or has not achieved the desired results, surgical interventions offer effective options. The modified Ravitch procedure is an open surgical technique involving an incision across the chest to access the sternum and ribs. During this procedure, the surgeon removes excess cartilage and may cut the sternum for flatter alignment. The sternum is then secured, and the chest wall closed.
Another surgical option is the reverse Nuss procedure, a minimally invasive approach. This technique involves making two small incisions on the sides of the chest. A specialized metal bar is then inserted under the skin, positioned in front of the sternum to apply inward pressure and reshape the chest. This bar remains in place for 2 to 3 years, before being removed in a subsequent outpatient procedure.
Recovery time varies depending on the surgical method. For the modified Ravitch procedure, patients stay in the hospital for 3 to 5 days, and full recovery can take 1 to 2 months. Pain management is an important aspect of post-operative care, involving a combination of medications. For the reverse Nuss procedure, hospital stays are around one week, with similar recovery expectations for returning to normal activities. Surgical correction can improve chest appearance and resolve physical symptoms. Risks include bleeding, infection, and pain.
Life After Correction
Following successful correction of pectus carinatum, individuals can expect a positive long-term outlook, regardless of the method used. The primary goal of treatment is to achieve a more typical chest shape, which can enhance body image and quality of life. Many report improved self-confidence and greater willingness to participate in previously avoided activities.
Long-term physical activity is encouraged, with a gradual return to exercise and sports as advised by healthcare providers. While recurrence of the deformity is uncommon after effective treatment, follow-up appointments are important to monitor progress and stability. Continued communication with healthcare providers is beneficial for addressing ongoing concerns and supporting well-being.