The Pediatric Surgery team at American Family Children's Hospital in Madison, Wisconsin, treat children with pectus carinatum, a protrusion of the breastbone (sternum) and rib cartilages.
What is pectus carinatum?
Pectus carinatum is a common pediatric condition characterized by an abnormal overgrowth of the rib cartilages, which results in protrusion of the breastbone (sternum) and rib cartilages. It is also known as pigeon chest. Pectus carinatum occurs four times as often in males as in females.
The cause of pectus carinatum is unknown. It may be genetically linked, considering its frequent occurrence in families.
What are pectus carinatum symptoms?
Many people with pectus carinatum will have chest pain, shortness of breath with activity, or decreased endurance. Some children and their parents report that the children feel significant embarrassment about the appearance of their chest.
How is pectus carinatum fixed?
Bracing is the treatment of choice for children with pectus carinatum. Bracing is very effective because the chest is still compliant (flexible) during childhood and adolescence.
This bracing system corrects the abnormal chest shape and allows remodeling by applying external compression (similar to the way braces correct crooked teeth). The pectus brace uses the least amount of pressure needed to fix the chest in order to maximize comfort. It will need to be adjusted (tightened) every few months until the chest has a normal appearance.
More About the Brace
- We recommend that the brace be worn as much as possible (23 out of 24 hours a day) every day for optimal correction. The brace only works when it is worn as prescribed. Wearing the brace as often as possible throughout the day and night (excluding showers and sports) will allow the best correction outcome.
- The length of time needed to wear the brace for complete correction will vary from person to person. Usually, the brace will need to be worn for six to 20 months. After the chest becomes a more normal shape, the brace will still need to be worn less (approximately eight hours per day).
- Most children say their chest is slightly sore after the initial brace fitting. This can be treated with ibuprofen (Motrin) or acetaminophen (Tylenol).
- The brace can easily be worn under clothes. A thin, tightly-fitting shirt may be worn under the brace for comfort.
- Your child may experience slight redness and pain on the front of the chest (at the site of the outward protrusion of the chest) from the brace. This is normal. If the brace causes a scratch or sore that is open, this is not normal and the brace should be removed. You should contact your physician if this occurs.
- If you remove the brace and the reddened area on the chest does not "blanche," remove the brace and call your physician. “Blanching” is when you press on the red area and it temporarily turns white and then back to red. Do not put the brace back on until the reddened area can blanche. If the problem continues, the child should not replace the brace until he/she can be seen in the clinic for adjustments.
- If your child has trouble sleeping with the brace on, try using memory foam or a similar-type padding over the mattress.
- Girls should not use the brace with an underwire bra as this may cause pain and skin breakdown.
What if the brace doesn't work?
If your child has worn the brace as prescribed for at least one year, we may consider surgery to correct his/her pectus carinatum. Surgery involves reshaping/removing the abnormal rib cartilages while preserving their outer layer. This outer layer is left to provide the foundation for new cartilage to grow.
The breastbone may also need to be revised and/or repositioned. An incision is made in the center of the chest to repair this abnormality. After the operation, drains (soft, flexible tubes) will be in place for three to six days, and will be removed when the volume of drainage decreases. Children are usually hospitalized for three to five days after the operation. Similar to the pectus excavatum recovery period, strict activity restrictions are usually expected for two to three months following surgery.