What is Pectus Carinatum?
Pectus carinatum, also known as 'pigeon chest' is a congenital deformity of the anterior chest wall, and occurs when the breast bone is pushed outward by an abnormal overgrowth of cartilage.
Pigeon chest affects around one in 1,000 people and is slightly less common than Pectus Excavatum. It is present at birth but often becomes more noticeable in early adolescence, when the ribcage and the rest of the body undergo growth spurts during puberty. Often both sides of the ribs are affected but in other cases it can appear asymmetrical with one side worse than the other.
Pectus Carinatum can also appear as part of another condition like scoliosis, but is also associated with rarer musculoskeletal syndromes like Marfan syndrome.
For patients considering LOC’s non-surgical treatments for pectus carinatum, the initial consultation is FREE with no obligation to proceed. During the consultation one of LOC's clinicians will examine your chest and also your general posture. They will look at your alignment from head to toe if required, looking for signs of asymmetry.
The exact cause of pectus carinatum is unknown, though it’s largely attributed to abnormal cartilage overgrowth between the bony ribs and the breast plate, causing the sternum – the breastbone – to buckle outwards (when it buckles inwards, this is referred to as Pectus Excavatum).
It is thought to be linked to hereditary as patients with pectus deformity usually have family members with the same condition. According to the American Board of Family Medicine about 40% of pectus patients have family members with a pectus condition but a genetic link is yet to be fully identified. For more information, head to our Causes page.
The breast bone protrudes out of the chest, causing it to bow out. Sometimes patients can suffer from a mixed deformity, half in and half out, so the chest appears asymmetrical.
Many who have pectus carinatum do not experience any further symptoms outside of their appearance. Some develop other associated complications listed below.
Psychological Impact of Pectus Carinatum
An important aspect of having a pectus deformity is the reduced self-esteem which often accompanies it. While some people accept the shape of their chest, for others it can be traumatic; causing anxiety, negative self-image, low self-confidence and increased self-consciousness.
Research consistently shows that pectus carinatum often has a negative effect on a person’s ability to interact with others, and is a compelling reason for many to seek corrective help. In a 30 year Californian study carried out by UCLA School of Medicine, the most common complaint for young patients was related to the unattractive physical appearance of the condition. In many cases, the cosmetic concerns and psychological effects are enough to warrant the need for treatment.
Many affected patients have no other physical symptoms, others may develop respiratory problems, some develop rigidity of the chest wall with decreased lung compliance or increased frequency of respiratory tract infections*
- Difficulty breathing during exercise
- Other respiratory problems
Surgery is a well-established method to treat pectus deformity and may improve a patient’s confidence. However, it carries the associated complications of having general anaesthesia and the risk of scarring.
While we do not offer surgical treatment, we provide non-surgical bracing for many chest shapes that are surgically operated on, and in some cases, we can work hand in hand with surgeons to use bracing pre/post-surgery. In our clinic, we find it difficult to justify surgery for anyone adolescent or younger for pectus carinatum if they have a flexible chest, because often it can be corrected by bracing. It’s a lot simpler to correct and the results, with compliance, can be very successful. For more information on surgical procedures, head to our Treatment page.
As one gets older, the chest becomes more rigid and results are sometimes harder to achieve. The chest is more malleable in adolescents and children and tends to get stiffer as the skeleton matures.
Patients with pectus carinatum who comply with the required exercises will respond well to orthotic bracing, and there are normally two phases; one initial phase until correction is achieved and the next phase for maintenance, during which the brace is only worn at night.
Our non-surgical LOCpectus treatment for pectus carinatum involves wearing a bespoke brace – the Dynamic Chest Compressor - combined with a programme of daily exercises. The brace applies constant pressure over the area of the chest that needs to be remodelled. Because pectus carinatum is caused by the chest protruding, we use a brace which fits over the apex of the chest to push it in – the dynamic chest compressor 1 – for the upper chest. In cases where the ribs protrude as well, the lower dynamic chest compressor 2 may be needed. As you push in the upper chest, the ribs tend to flare out so we use this lower brace to push the ribs back in.
It is now several years since we introduced this new treatment for pectus carinatum, and we are building up ever more convincing, successful case histories. The most important factor in achieving a good result is compliance to the treatment programme and regular reviews preferably in clinic, or via Skype consultations.
Length of treatment varies on the age of the patient, the elasticity of the chest and the severity of the pectus carinatum. All pectus braces and treatment are tailored bespoke to each individual’s needs.
You can find out more about bracing treatment for pectus carinatum on our LOCpectus page.
*(Coskun ZK, Turgut HB, Demiroy S, Cansu A. The prevalence and effects of Pectus Excavatum and Carinatum on the respiratory function in children between 7-14 years old. Indian J Pediatr. 2010. Sep. 77(9):107-9 [Medline]