What Is Pectus Carinatum?
Pectus carinatum, also known as pigeon breast or pigeon chest, causes your breastbone and ribs to push outward. Pectus carinatum typically becomes obvious between the ages of 11–16, but it can also show up in very young children. Pectus carinatum does not always require treatment. When we do treat pectus carinatum, we almost always use a brace instead of surgery.
At least one per 1,000 people have pectus carinatum. The condition is more common in males than females and usually appears during puberty or early adolescence. In newborns, pectus carinatum may look like a rounded chest and then worsen at age two or three.
Utah Pectus Program
University of Utah Health provides expert care for children, adolescents, and young adults who have chest wall deformities. Specialists at the Utah Pectus program are experts in pectus deformities such as pectus carinatum and pectus excavatum. We see between 100–150 people each year who have pectus carinatum.
We know pectus deformities can cause emotional and physical challenges. Our pediatric specialists are here to find the best treatment option for you.
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Pectus Carinatum Causes
Pectus carinatum occurs when a child’s breastbone and ribs jut outward while they grow. Experts don’t know why some people develop this condition while others don’t. Pectus carinatum tends to run in families, which suggests that genetics play a role. Sometimes you’ll have other problems along with pectus carinatum:
- Spine conditions such as scoliosis (sideways curvature of the spine) and kyphosis (outward curvature of the spine)
- Connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome
Pectus Carinatum Symptoms
People with pectus carinatum typically don’t have symptoms. If they do, these symptoms are mild. Symptoms might include occasional pain and tenderness of your chest wall.
Even without physical symptoms, pectus carinatum can be difficult for children and adolescents. Many feel self-conscious about their appearance and suffer from poor body image or low self-esteem.
Pectus Carinatum Treatment
Physicians who treat patients with pectus carinatum are pediatric surgeons. However, most patients don’t need surgery. Specialists can treat about 95% of people with pectus carinatum using a customized chest-wall brace. Your child’s pediatric surgeon will help you learn about each of the treatment options available to you and advise you on what is best for your child’s condition.
Chest-Wall Brace
The brace applies gentle pressure to the chest wall, which gradually reshapes the chest wall without discomfort. Bracing works well because the chest wall in children and adolescents is soft and flexible. Treatment time is usually 12–18 months. At first, children wear the brace most hours of the day and night. Over time, they may be able to decrease the number of hours in a day they wear the brace.
Surgery
The pediatric surgeon may recommend a surgical procedure called the Ravitch technique. Specialists only suggest this surgery if you have a severe chest wall deformity. The Ravitch technique involves cutting away the abnormal rib cartilage and flattening the sternum. U of U Health pediatric surgeons are the only board-certified pediatric surgeons in the state of Utah, and they have extensive experience with the Ravitch technique.
What to Expect at Your Appointment
Preparing for Your Appointment
If your child has had a chest X-ray recently, we will want those images transferred into the U of U Health system before your child’s evaluation appointment. The scheduler will talk to you about that when you make your appointment.
Pectus Carinatum Diagnosis
During your child’s evaluation, the pediatric surgeon will do a physical. We may take pictures of your child’s pectus carinatum before surgery. Girls should wear a sports bra since they will need to remove their top for part of the evaluation.
Pediatric specialists can usually diagnose pectus carinatum without taking a chest X-ray during this visit.
If the pediatric surgeon determines that your child has pectus carinatum and would benefit from bracing, he or she will refer you to a bracing specialist close to your hometown. You can make an appointment with this specialist at your convenience. Please return to the Utah Pectus Program clinic for a one year follow-up appointment.
If your child needs surgery to correct their pectus carinatum, the pediatric surgeon will talk to you about the next steps.
Chest Brace for Pectus Carinatum
The bracing specialist provides a thorough evaluation and takes measurements of your child’s chest. Sometimes a standard brace fits, but most children need a brace that’s customized just for them.
Most children wear the brace 16–18 hours a day for 12–18 months. The more your child wears the brace, the faster their chest wall will develop a normal shape. Most people aren’t bothered when they wear the brace. The brace’s design is simple and not noticeable under baggy tops. You can wear the brace at school, during exercise, and while sleeping. Some braces are waterproof, so you can wear it while swimming.
Your child will visit the bracing specialist occasionally for check-ups. Most children wear the same chest-wall brace during their course of treatment. The brace is adjustable, and you can tighten it as needed.
Insurance Coverage for Pectus Carinatum Care
Insurance companies typically don’t cover the cost of a brace unless a child’s pectus carinatum causes symptoms such as shortness of breath or chest pain. But we recommend asking your insurance about coverage to make sure. Factors such as materials and the degree of correction determine the cost of treatment.
Your insurance plan may cover the cost of the initial evaluation at U of U Health. Please be sure to review your coverage plan with your insurance company before your appointment.
Making an Appointment with the Utah Pectus Program
You can call 801-662-2950 to schedule an appointment or request an appointment online. A referral is not required, but your insurance plan may require one. Your primary care provider can fax a referral to 801-662-2980, call 801-662-2950, or complete our online referral form.
Hear From Our Specialists
What Is Pigeon Chest and How Is it Treated?
Pectus carinatum or pigeon chest, is a genetic disorder that makes the chest wall jut out during puberty. While the condition may cause only minor physical issues, it can have a significant impact on a teenager's self-esteem. Pediatric surgeon Dr. Stephen Fenton explains what causes the condition and what corrective treatments are available.