Utah Pectus Program

University of Utah Health provides expert care for children, adolescents, and young adults who have pectus carinatum. This condition, also known as pigeon breast or pigeon chest, causes the breastbone and ribs to push outward. Although it can show up in very young children, pectus carinatum typically becomes obvious between the ages of 11 and 16.

Pectus carinatum is almost always treated with a brace, and not with surgery. Specialists with the Utah Pectus Program see between 100 and 150 people each year who have pectus carinatum. This means they have extensive experience diagnosing and treating this condition.

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Learn About Pectus Carinatum

Pectus carinatum occurs because of an overgrowth of rib cartilage, but experts don’t know why some people develop this condition and others do not. Pectus carinatum tends to run in families, which suggests that genetics play a role. Sometimes the condition is associated with other problems, including:

  • spine conditions such as scoliosis (sideways curvature of the spine) and kyphosis (outward curvature of the spine) and
  • connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome.

Pectus carinatum occurs in at least one per 1,000 people. The condition is much more common in males than females and usually appears during puberty and early adolescence. In newborns, pectus carinatum may look like a rounded chest and then worsen at age two or three.

People with pectus carinatum typically do not have symptoms. If they do, these symptoms are mild and include occasional pain and tenderness of the 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, surgery is rarely necessary. About 95 percent of people with pectus carinatum can be treated using a customized chest-wall brace.

Chest-Wall Brace

The brace applies gentle pressure to the chest wall, gradually reshaping 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. Initially, people 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 for people with pectus carinatum who 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.

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.

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.

jones-banner.jpgPectus Carinatum Diagnosis

During your child’s evaluation, the pediatric surgeon will do a physical, and take “before” pictures. Girls should wear a sports bra since they will need to remove their top for part of the evaluation.

Doctors 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 the pectus carinatum, the pediatric surgeon will talk to you about the next steps.

 

Chest Brace for Pectus Carinatum

The bracing specialist will provide a thorough evaluation and take measurements of your child’s chest. Sometimes a standard brace will work, but most children need a brace that is customized just for them.

Most children wear the brace 12–23 hours a day for 12–18 months. The more your child wears it, the faster the chest wall will develop a normal shape. Most find that wearing a brace is not bothersome. Its design is “low profile,” which means it is 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 can be tightened as needed.

Insurance Coverage for Pectus Carinatum Care

Insurance companies typically do not cover the cost of a brace unless a child’s pectus carinatum is causing symptoms such as shortness of breath or chest pain. It is worth asking, but families usually pay out of pocket for this therapy. Materials and the degree of correction necessary are some of the factors that determine the cost.

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 to be sure.

Making an Appointment with the Utah Pectus Program

Physician referrals are welcome but not necessary when making an appointment with the Utah Pectus Program. To request an appointment, call 801-662-2950 or complete our online form.