What is pectus carinatum?
Pectus carinatum (PECK-tuss care-uh-NAW-tum) is a breastbone (sternum) and rib cartilage deformity that causes the chest to bow outward. It is caused by a defect in the tough connective tissue (cartilage) that holds the ribs to the breastbone. It is sometimes called “pigeon chest” because the chest can look like a bird’s breast. The condition may cause pain. The opposite condition, called pectus excavatum, makes the cartilage grow inward, causing a dent in the chest.
Pectus carinatum in children
Pectus carinatum affects about 1 in 1,500 children and is more common in boys than girls. The condition usually affects only 1 person in a family.
Our surgery team at Seattle Children’s has seen hundreds of children with pectus carinatum and sees dozens of cases each year. Most of these children can live normal, active childhoods without any treatment. When a child needs treatment, we work to develop a plan that is tailored to the patient and family. We take a conservative approach and, in most cases, can avoid surgery and correct the condition with a brace.
Our surgeons are specially trained in pediatric surgery and have special expertise in children with chest wall conditions. They focus on how today’s treatment will affect your child as they develop and become adults. We base treatment plans on years of experience and the newest research on what works best — and most safely — for children and teens. This experience helps us easily diagnose your child’s condition and work with you to decide on the best treatment.
At Seattle Children’s, your family has a full team behind you, from diagnosis through treatment and follow-up. From our appointment schedulers to our pediatric nurses, our team is specially trained to work with children and their families. Our facilities and equipment also reflect this kid-friendly, family-centered approach.
In pectus carinatum, the cartilage that holds the ribs to the breastbone pushes out from the chest, causing it to bow outward. You might notice pectus carinatum when your child is a baby, but it often isn’t noticeable until a child gets older. The condition may get more obvious as your child grows, particularly during growth spurts.
In most children, the problem is the same on both sides of the breastbone. Occasionally, children have the problem on 1 side. Rarely, the cartilage bows outward in only 1 spot in the chest.
Pectus carinatum usually doesn’t cause any symptoms. When it does, pain is the most common symptom. This pain might occur when a child moves awkwardly, lies down the wrong way or is hit while playing sports.
Diagnosing Pectus Carinatum
During your first visit to Seattle Children’s, the doctor will examine your child and ask about any symptoms. Since we have seen hundreds of children with pectus carinatum, we rarely need X-rays to diagnose it. This saves your child from being exposed to radiation.
Treating Pectus Carinatum
Our surgery team takes a conservative approach when treating pectus carinatum and, in most cases, can avoid surgery by correcting the condition with a brace.
Braces for pectus carinatum
We can often use a brace to reshape a child’s chest. The brace works in the same way that braces move teeth. Gentle, constant pressure on the breastbone pushes it into a normal position. Our Orthotics and Prosthetics Department makes these braces, and we custom-fit them to your child. Most children need to wear the brace for 12 hours or more a day, for at least 1 year.
Your child’s surgeon works with the Orthotics and Prosthetics team to check your child’s chest regularly and adjust their brace. You may see improvements within a few months. This treatment approach has been successful for many patients at Seattle Children’s with pectus carinatum over the years.
Surgery for pectus carinatum
We try to avoid surgery, but a small percentage of our patients need an operation to move the breastbone back into a normal position.
Our surgeons will explain the surgical procedure and answer any questions you have. Before surgery, we will give your child general anesthesia, a type of medicine that makes them sleep so they don’t feel pain.
The surgeon will make a cut (incision) in the chest, remove the cartilage that pushes the breastbone forward and cut the breastbone so it will lie flat. Over time, the cartilage will regrow to support the breastbone in its new position. The surgery takes about 2 to 6 hours.
Your child will be in the hospital for 1 to 7 days, depending on their surgery. Before your child goes home, we will teach you how to give your child pain medicine and how to care for your child’s incision by keeping it clean and dry. You should also limit your child’s activity while they recover. Your child should:
- Sit up straight for the first month after surgery
- Avoid lifting anything heavy for a few months
- Avoid playing sports for 6 to 8 weeks
You will need to return for a follow-up visit with the surgeon about 2 to 3 weeks after surgery to make sure the incision is healing and that your child is recovering well. Our providers and nurses are always available to answer your questions.