Children with the chest wall deformities known as pectus carinatum (pigeon chest) and pectus excavatum (sunken chest) can face physical and emotional burdens. When that’s the case, corrective treatment — surgery for pectus excavatum and nonsurgical bracing for pectus carinatum — can offer significant benefits.
Treatment can help improve the chest’s appearance and lead to a better quality of life. The ideal time for pectus excavatum surgery is 12 to 15 years old. Nonsurgical bracing can take place even earlier than that.
It’s important to discuss treatment options for pectus carinatum and pectus excavatum with your child’s doctor. This article will outline pectus excavatum and pectus carinatum and when to seek treatment.
What Is Pectus Excavatum?
Pectus excavatum — also known as sunken chest or concave chest — occurs when the breastbone and rib cage grow inward. The condition causes people to have a hollow or sunken-looking chest. The depression in their chest can range from shallow to deep.
Pectus excavatum is the most common congenital chest wall deformity. It’s either present at birth or develops later. It often gets worse during growth spurts.
The condition can cause children to have body image or self-esteem issues because of how their chest looks.
“What you’ll notice is that the kids will have a tendency to not want to take their shirts off,” says Shawn Safford, MD, pediatric surgeon, UPMC Children’s in Central Pa. “They become very embarrassed by it.
“I subset these kids into two very specific types of kids. There are kids who absolutely don’t care about it, and there are kids who are horrendously affected by it.”
In severe cases, pectus excavatum can also cause physical symptoms because of the sternum pressing on the heart and lungs. Children may experience heart palpitations, shortness of breath, and difficulty exercising.
“Generally, what can happen is kids can get some kind of exercise intolerance,” Dr. Safford says. “For some kids, it compresses the heart enough that they’ll pass out when they try to do anything more than walk. So, it sometimes means passing out with exercise or not keeping up with their friends at school.”
What Is Pectus Carinatum?
Pectus carinatum — also known as pigeon chest or chicken breast chest — happens when the sternum and rib cage grow outward. It causes the front of the chest to stick out more than normal.
Like pectus excavatum, pectus carinatum often gets worse when kids go through growth spurts. It can also cause children to experience body image or self-esteem issues because of the look of their chest.
However, unlike pectus excavatum, pectus carinatum doesn’t usually cause physical symptoms.
“Pectus carinatum is primarily a cosmetic issue, so it generally is not going to cause any physiologic problems,” Dr. Safford says. “A child can grow and be healthy and have a normal, healthy life. But most kids will want to get it taken care of because it’s a cosmetic (issue), and a lot of kids are embarrassed about it.”
When to Seek Treatment for Pectus Excavatum or Pectus Carinatum
When your child gets a pectus excavatum or pectus carinatum diagnosis, it’s important to meet with a pediatric surgeon who specializes in chest wall deformities. They can talk with you about whether it’s appropriate for treatment.
“We have the initial conversation to talk about, ‘What are the things to look for?’” Dr. Safford says. “‘What are those physiologic changes? What are the psychological triggers where you need to potentially think about this a little more closely?’”
Dr. Safford says the most important factor in getting treatment is whether the child wants it. Although many children experience self-esteem issues because of their condition, many others do not.
“This is a surgery that the parents have to consent for, which means they can say no, but the child has to assent for — which means they have to say yes,” Dr. Safford says.
If your child’s pectus excavatum is causing physical symptoms, they may have a greater need for treatment. They may also need to meet certain criteria for the depth of their chest impression. The Haller index, which uses CT scans, measures this.
What Is the Right Age for Pectus Excavatum and Pectus Carinatum Treatment?
The right time for pectus excavatum surgery is 12 to 15 years old, Dr. Safford says. Although you can get surgery into adulthood, chest bones are more pliable at a younger age.
Nonsurgical bracing for pectus carinatum can take place even earlier, Dr. Safford says. Talk to your child’s doctor about the appropriate age to begin treatment.
Surgery for Pectus Excavatum
The surgery for pectus excavatum is known as the Nuss procedure. It involves the placement of a metal bar underneath the sternum using cameras and small incisions. Over time, the bar pushes the sternum upward to its typical position.
“The operation is minimally invasive, but I say that it’s maximally impactful,” Dr. Safford says.
After the surgery, children have to go through a recovery process. The child will have significant physical limitations for the first few weeks. After three months, only contact sports are off-limits.
The bar remains in place for about three years before your child’s surgeon removes it in an outpatient procedure.
Pectus Carinatum Treatment
The typical treatment for pectus carinatum involves wearing a fitted compression brace over the chest. Children should wear the brace for about six months. Over that time, the brace will push the sternum downward into its more typical position.
At first, children need to wear the brace for 23 hours a day, Dr. Safford explains. Over time, with guidance from their doctor, they can decrease wearing the brace to around eight hours a day.
The treatment requires a commitment from the families to follow those instructions, Dr. Safford notes.
“A lot of times, these interventions have to be paid out of pocket because it’s considered cosmetic,” he says.
“And so, with that, the conversation is significant with the family and needs to include the child because of the understanding that the brace must be worn 23 hours a day. They can take it off for showers, exercise, or sports, but otherwise, they have to wear the device. That’s a real conversation you have to have with the kids.”
How Effective Is Treatment for Pectus Carinatum and Pectus Excavatum?
Dr. Safford says pectus excavatum surgery and pectus carinatum bracing can have major psychological and physiological impacts on children. The treatments can effectively improve the appearance of the chest, which can ease body image problems.
Pectus excavatum surgery also can relieve heart- and lung-related physical symptoms. That relief can make it easier for people to exercise.
If you or your child has pectus carinatum or excavatum, it’s important to talk to a doctor about treatment options. When the child has started their evaluations with their pectus surgeon, they’ll most likely go in yearly to ensure no significant changes have developed.
“My patients have had great results, and they’ve all been very happy that they had the operation,” Dr. Safford says. “Really, the biggest impact is ensuring that you’re screening for the kid who wants the operation and appropriate expectations are set for what they want afterward.”