Pectus carinatum, commonly known as “pigeon chest,” is a structural deformity characterized by an outward protrusion of the sternum (breastbone) and adjacent costal cartilage. This condition, which affects the anterior chest, may be noticeable in early childhood but often becomes more pronounced during adolescent growth spurts. While generally benign physically, effective non-surgical and surgical options are available for correction. Seeking treatment can significantly address both physical symptoms and associated psychological distress.
Understanding Pectus Carinatum
Pectus carinatum results from the overgrowth of cartilage connecting the ribs to the sternum, which pushes the breastbone forward. This protrusion can be symmetrical, or it may be asymmetrical, with a bulge on one side of the chest wall and a corresponding flattening on the other. It is the second most common chest wall deformity and occurs more frequently in males than in females, often becoming most apparent around age 11 or later in the teen years.
A strong genetic component is suggested for the cartilage overgrowth, with a family history of chest wall deformities present in up to one-third of cases. The deformity is occasionally associated with connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, and may also occur alongside scoliosis. Diagnosis is typically made through a physical examination. Imaging, such as a chest X-ray or Computed Tomography (CT) scan, may be used to assess severity, measure the protrusion, and determine the flexibility of the chest wall to guide treatment choice.
Non-Surgical Treatment Options
For patients whose chest wall is still flexible, typically those in pre-adolescence or early adolescence, external compression bracing is the primary treatment. This non-invasive method works similarly to orthodontic braces, applying continuous, targeted pressure to reshape the malleable cartilage and sternum over time. The custom-made brace consists of a rigid back plate and a front plate that presses directly onto the protruding sternum.
The mechanism relies on consistent pressure application to remodel the still-growing cartilage, gradually pushing the sternum back into a normal position. Success depends heavily on patient compliance, requiring the brace to be worn for a minimum of 8 to 12 hours a day during the initial correction phase. Treatment duration varies based on the severity of the deformity and the patient’s growth rate, commonly lasting between six months and two years.
Regular follow-up appointments are necessary to monitor progress and adjust the brace pressure as the chest wall responds to treatment. Once correction is achieved, the patient transitions to a maintenance phase, wearing the brace less frequently, often only at night, until skeletal maturity prevents recurrence. Bracing is highly effective for compliant patients and avoids the risks and recovery time associated with surgery.
Surgical Correction Procedures
Surgery becomes necessary when bracing is unsuccessful, the deformity is severe, or the patient has passed skeletal maturity and the cartilage is no longer flexible enough to be reshaped. The two principal surgical approaches are the open method and the minimally invasive technique. The traditional open approach is the Modified Ravitch Procedure, which involves making a long incision, removing the overgrown costal cartilage, and performing an osteotomy on the sternum to reposition it.
The Modified Ravitch Procedure fundamentally “breaks and resets” the front of the chest wall, allowing the surgeon to excise the excessive cartilage and reposition the sternum. A minimally invasive option, often referred to as a modified Nuss or Abramson technique, is also used, which involves implanting a stabilizing bar that applies internal pressure to flatten the sternum. The Ravitch approach is frequently considered the definitive correction, particularly in older patients or those with complex deformities.
Recovery from either surgical procedure requires limited physical activity for several weeks to allow the chest wall to heal and stabilize. If a minimally invasive bar is placed, it remains in place for an average of two to four years before surgical removal. The choice of procedure depends on factors like the patient’s age, the specific type and severity of the deformity, and the surgeon’s experience.
Health and Lifestyle Considerations
While many individuals are asymptomatic, severe cases can lead to functional impairment affecting both the pulmonary and cardiac systems. The rigidity of the chest wall can restrict the full expansion of the lungs, leading to reduced pulmonary capacity and shortness of breath during strenuous physical activity. This restriction may manifest as exercise intolerance. The outward sternal pressure can also compress or displace the heart, leading to cardiac issues such as mitral valve prolapse. Beyond the physical symptoms, the cosmetic appearance can cause significant psychological distress, low self-esteem, and social self-consciousness, especially in adolescents. This is often a primary motivator for seeking treatment, as successful correction improves body image and overall quality of life.