A Guide on How to Fix Pectus Carinatum

by Dakota Brace

What Is Pectus Carinatum?

Pectus carinatum, or pigeon chest, is a congenital condition where the breastbone region sticks out from the middle of the chest. This occurs due to overgrowth of the breastbone cartilage. Pigeon chest can be classified into two main categories, depending on which region of the breastbone is protruding.

If the upper breastbone region sticks out, this is known as chondromanubrial prominence and is generally more severe. The more common form (comprising 92-99% of all pectus carinatum cases) is chondrogladiolar prominence, where the lower/middle region of the breastbone sticks out.[1]

Causes and Symptoms of Pectus Carinatum

The exact causes of pectus carinatum are unknown; however, its incidence appears to be related to a combination of genetic, environmental, and random factors.[2] In terms of genetic influence, around a quarter of all people with this condition also have an affected family member.[3]

Pigeon chest is significantly more common in males compared to females. Various authors have reported the incidence ratios of male-to-females as 4:1,[2] 5:1[4] and even as high as 5-9:1.[5] Most authorities report an incidence of roughly 1 in every 1,500 births (0.07%) for pigeon chest;[6] however cohort studies of middle school students have estimated incidence rates of 0.6% in Turkey[7] and 0.7% in Brazil.[8] 

In some individuals, pectus carinatum occurs in association with other syndromes, most commonly Marfan syndrome or Noonan syndrome. However, it may also occur in conjunction with:

  • Morquio syndrome
  • Poland's syndrome
  • Ehlers-Danlos syndrome
  • Osteogenesis imperfecta
  • Homocystinuria, and
  • Coffin-Lowery syndrome

Only 10% of pectus carinatum cases are diagnosed before puberty, as the symptoms are less obvious before the rapid growth spurt which children experience during their teenage years.[4] Non-surgical treatment also generally shows the best results when conducted during the teenage years, while the breastbone cartilage is more flexible and compliant.

Common symptoms of pigeon chest that usually become evident during puberty include:

  • Jutting out of the breastbone region.
  • Poor posture; hooked shoulders; hunched back.
  • Excessive curvature of the spine — either sideways (scoliosis) or outward (kyphosis).
  • Being short of breath or breathing unusually fast (asthma-like symptoms), particularly during physical exertion.
  • In more severe cases, a fast heart rate and/or chest pain.
  • Feeling fatigued and lethargic.

How to Fix Pectus Carinatum - Dakota Brace

How to Fix Pectus Carinatum

In most cases of pigeon chest, the major issues associated with the condition are related to appearance and self-esteem.[9] However, the most severe cases can affect cardiopulmonary function due to compression of the chest region.

Up until the last few decades, invasive surgery was the principal recourse for treating pectus carinatum. However, significant strides have been made in the treatment methods and patient outcomes for this condition in recent years.

Less invasive forms of surgery, such as the Abramson method or modified Ravitch method, are highly effective with lower complication rates.[10] Nevertheless, surgery is still only recommended for severe cases of pectus carinatum.

For most patients, the use of a compression chest brace for pectus carinatum is recommended as a first treatment method. In the rare cases where the patient fails to respond to brace treatment, the option of surgery is always available later.[11]

Chest Braces for Pectus Carinatum

The treatment of pectus carinatum using a chest brace generally involves wearing a lightweight brace that compresses the chest around the protruding breastbone region. Over an extended period (usually 6-12 months), this remodels the growth pattern of the breastbone cartilage, reshaping the breastbone region to the desired shape.[12]

The amount of compression can be adjusted, depending on the magnitude of the breastbone deformity and the body’s response to the applied pressure. Usually, treatment will begin at a lower pressure (2.5-3 PSI) and be increased if required.[13] Excessive compression force should be avoided, as this can also lead to patient discomfort and/or skin lesions.[13] 

The younger the patient, the more effective and faster results are generally obtained using a compression brace.[14] Consequently, treatment should commence as early as possible. Numerous clinical studies have demonstrated the effectiveness and suitability of chest braces for treating pectus carinatum, with treatment usually taking 6-12 months for results.[15-17]

After this period, most patients move to maintenance bracing, where the brace is worn for reduced periods (8-12 hours/day) until skeletal growth ceases (usually 1-1.5 years). After the maintenance period is completed, recurrence of the condition is extremely rare. 

A complete lack of response to bracing treatment is quite rare, with clinical studies suggesting that only 2-11% of patients fail to respond. However, the principal reason for the failure of a pigeon chest brace to provide effective results is a lack of compliance.[18-19]

This may be due to patient discomfort or self-consciousness resulting from poorly fitting or excessively bulky braces.[13] Consequently, an effective chest brace for pectus carinatum should be custom-fitted to your child and have a low profile. 

Dakota Brace - Pectus Carinatum Chest Brace

This is where custom braces produced by Dakota Brace can help. In contrast to other generic, low-quality braces for pectus carinatum, each one of our braces is custom-built for the patient.

A 3D scan of your child’s chest is used to design a brace that will perfectly fit your child and ensure their comfort. The brace is 3D printed to reduce turn-around time while ensuring they match your child’s body shape.

The brace also has easily adjustable Boa straps to ensure the right amount of pressure is being applied while the body changes during wear time. Every step is performed under the supervision of our team of certified clinicians.

Additionally, every step can be performed remotely,* allowing us to work around your schedule without compromising on quality. 

Are you ready to restore your child’s health and confidence? Click here to get a free consultation and an additional 10% off your first order with Dakota Brace. 

*Note: You will need access to an iPhone X or later to do your initial scan.

FAQs (Frequently Asked Questions)

How many people have pectus carinatum?

Pectus carinatum is the second most common chest abnormality, occurring in 1 in every 1500 births (0.07%); meaning that over 100,000 people in the United States are living with this condition.

However, some studies have suggested that the true incidence of pectus carinatum may be higher than previously thought. One study from Brazil reported that 0.7% of middle schoolers surveyed had pectus carinatum. Similarly, an incidence rate of 0.6% has been reported for middle school students from Turkey.

How to fix pectus carinatum?

Historically, surgery was the primary treatment method for pectus carinatum, but is now only recommended for severe cases or situations where orthotic bracing fails. This is fortunately quite rare, with clinical studies suggesting that only 2-11% of patients fail to respond to bracing treatment.

How long does pectus carinatum brace take?

The majority of affected kids have to wear the brace anywhere between six months to a year, but some may need to wear it for longer. They have to wear it at least eight hours a day. Of course they can remove it for showering, sports, and similar activities.

Ready to restore your child’s health and confidence? Click here for your free consultation and get $75 off your first order, and get evaluated for either our Custom Pectus Brace (The Dakota Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace).

References:

  1. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.
  2. Cobben, J. M., Oostra, R. J., & van Dijk, F. S. (2014). Pectus excavatum and carinatum. European Journal of Medical Genetics, 57(8), 414-417.
  3. Shamberger, R. C. (1996). Congenital chest wall deformities. Current Problems in Surgery, 33(6), 469-542.
  4. Abdullah F, Harris J (2016) Pectus excavatum: more than a matter of aesthetics. Pediatr Ann, 45:e403–e406.
  5. Robicsek, F., Watts, L. T., & Fokin, A. A. (2009, March). Surgical repair of pectus excavatum and carinatum. In Seminars in thoracic and cardiovascular surgery (Vol. 21, No. 1, pp. 64-75). WB Saunders.
  6. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
  7. Coskun, Z. K., Turgut, H. B., Demirsoy, S., & Cansu, A. (2010). The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7–14 years old. The Indian Journal of Pediatrics, 77(9), 1017-1019.
  8. Westphal, F. L., Lima, L. C. D., Lima Neto, J. C., Chaves, A. R., Santos Júnior, V. L. D., & Ferreira, B. L. C. (2009). Prevalência de pectus carinatum e pectus excavatum em escolares de Manaus. Jornal Brasileiro de Pneumologia, 35, 221-226.
  9. Özkaya, M., & Bilgin, M. (2018). Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience. General Thoracic and Cardiovascular Surgery, 66(11), 653-657.
  10. Geraedts, T. C., Daemen, J. H., Vissers, Y. L., Hulsewé, K. W., Van Veer, H. G., Abramson, H., & de Loos, E. R. (2021). Minimally invasive repair of pectus carinatum by the Abramson method: A systematic review. Journal of Pediatric Surgery. DOI: 10.1016/j.jpedsurg.2021.11.028. 
  11. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.
  12. Lee, R. T., Moorman, S., Schneider, M., & Sigalet, D. L. (2013). Bracing is an effective therapy for pectus carinatum: interim results. Journal of Pediatric Surgery, 48(1), 184-190.
  13. Emil, S. (2018). Current options for the treatment of pectus carinatum: When to brace and when to operate?. European Journal of Pediatric Surgery, 28(04), 347-354.
  14. Martinez-Ferro, M., Fraire, C., & Bernard, S. (2008, August). Dynamic compression system for the correction of pectus carinatum. In Seminars in pediatric surgery (Vol. 17, No. 3, pp. 194-200). WB Saunders.
  15. Cohee, A. S., Lin, J. R., Frantz, F. W., & Kelly Jr, R. E. (2013). Staged management of pectus carinatum. Journal of Pediatric Surgery, 48(2), 315-320.
  16. Colozza, S., & Bütter, A. (2013). Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. Journal of Pediatric Surgery, 48(5), 1055-1059.
  17. Lee, S. Y., Lee, S. J., Jeon, C. W., Lee, C. S., & Lee, K. R. (2008). Effect of the compressive brace in pectus carinatum. European Journal of Cardio-Thoracic Surgery, 34(1), 146-149.
  18. Kang, D. Y., Jung, J., Chung, S., Cho, J., & Lee, S. (2014). Factors affecting patient compliance with compressive brace therapy for pectus carinatum. Interactive CardioVascular and Thoracic Surgery, 19(6), 900-903.
  19. Pessanha, I., Severo, M., Correia-Pinto, J., Estevão-Costa, J., & Henriques-Coelho, T. (2016). Pectus Carinatum Evaluation Questionnaire (PCEQ): a novel tool to improve the follow-up in patients treated with brace compression. European Journal of Cardio-Thoracic Surgery, 49(3), 877-882.
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