Pectus Carinatum

also called pigeon breast

Pectus carinatum, also called pigeon breast, develops because of a growth disorder in the rib cartilage next to the sternal bone. Due to an accelerated growth the sternal bone is displaced forwards. This growth occurs especially during the growth spurt of puberty, and this is why we see a progression of the pigeon breast during this period. The exact cause of this accelerated growth is unknown, but it can be caused by the use of certain medicines, pulmonary disorders or previous surgery on the chest wall. The displacement can be found on the higher or lower part of the chest wall and can be either symmetrical (on both sides) or asymmetrical. Genetics play a role in 25-30% of cases, more people in the same family can be affected. Most cases of pigeon breast are isolated pigeon but it may occur with scoliosis, cardiac anomalies and other syndromes or fibrous tissue disorders (Marfans disease)

One of the most important reasons to treat pigeon breast is the cosmetic aspect and the possible psychosocial impact during puberty. One could be ashamed for the deviant shape of the chest wall, and children are sometimes bullied by peers. A pigeon breast may lead to physical complaints such as pain, dyspnoea, fatigue and exercise intolerance.

When you visit a doctor, he would first ask you some questions to get more details about your chest wall deformity. For instance

  • What kind of complaints do you have?
  • Are you being bullied?
  • Are you the only one in your family with a funnel chest?

After that the doctor will examine your chest wall. Depending on the shape of your chest wall your physique and other information on chest wall deformities or other anomalies in your family, the doctor could decide to perform some additional examinations for example: an ultrasound of your heart, a CT or MRI scan. It could also be necessary to consult a cardiologist, orthopaedic surgeon or see a clinical geneticist.

A pigeon breast can be treated in several ways:

  1. Surgery: The malformed cartilage next to the sternal bone is removed and the sternal bone will be moved backwards (Ravitch procedure). The cartilage will grow back in the first six weeks after surgery. Sometimes it is necessary to reconstruct the sternal bone or fixate it with a plate and screws.
  2. Non-surgical: The sternal bone can be forced back into its place by an external compression brace This works just like dental braces; the pressure of the brace gradually moves the chest wall in the normal position. If it works, no surgery is needed.

Both treatments can be very effective, but not all pigeon breast deformities are suitable for a brace. What treatment suits you best depends on certain factors: the severity and rigidity (stiffness) of your pigeon breast, previous surgery, motivation et cetera. The doctor will discuss the best options for you after his examination.

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