Avoiding Pectus Carinatum Surgery: Why Bracing Works

Understanding Pectus Carinatum in Kids

Pectus carinatum (pigeon chest) is a birth defect which results in overgrowth of the breastbone cartilage during puberty. This causes the breastbone region to stick out or protrude in comparison to the rest of the chest. Cases of pectus carinatum are classified according to which region of the breastbone protrudes the most; with cases with upper breastbone protrusion generally being more severe.[1] Flaring of the lower rib cage can also occur in conjunction with this condition.

Pectus carinatum is four to five times more common in males than females.[2,3] It is relatively uncommon, occurring approximately 1 in every 1500 births. [4] Although its exact causes are still under investigation, there appears to be a genetic link. In other words, having family members with this condition increases a child’s chance of developing pigeon chest. [5] The chance of having pectus carinatum is also increased in children with a range of other syndromes, including Marfan syndrome or Noonan syndrome. 

What Are the Signs of Pectus Carinatum in Kids?

Children with pectus carinatum are largely asymptomatic in their early years of life, with 9 out of 10 cases not diagnosed until 10 years of age or older. During puberty, the rapid growth of the breastbone cartilage makes this condition much more obvious.

However, there are several early warning signs of this pectus carinatum, including protruding sections of the chest, having poor posture and hooked shoulders, being short of breath or experiencing a tight chest, experiencing a fast heartbeat or chest pain, and having a curved spine.

These signs may also become more prominent during puberty. As previously mentioned, parents of children with a family history of pigeon chest or its associated syndromes should be particularly vigilant about watching out for these warning signs.

Why Pectus Carinatum Surgery Should Not Be the First Option

Pectus carinatum is rarely, if ever, a self-resolving condition. In other words, it will not improve if just left alone. In most cases, treatment should be initiated as soon as possible, as better results will be obtained. There are two main approaches to the treatment of pectus carinatum: surgical and non-surgical treatment.

Historically, surgery was the only treatment option available for pigeon chest. The most common surgical method is the Ravitch procedure, which is a moderately invasive surgery performed under general anesthesia. Consequently, this can be a scary process for most children.

The Ravitch procedure involves creating an incision in the chest to expose the ribs, and another incision in the perichondrium (the fibrous lining that covers the outside of the breastbone cartilage). The abnormal cartilage growth is then removed from the breastbone to correct the protrusion. In some patients, the breastbone needs to be cut (an “oestomy”) and repositioned further downward in the chest.

A metal plate may be used to keep it in the correct place while the cartilage connections reform. The perichondrium is then sewn back together, which also helps prevent the pectus carinatum from relapsing. The recovery process is quite painful, with an average hospital stay of 4 days following surgery.[4] Patients are usually on painkillers for several weeks after the operation.

Some patients will have a drainage tube left in their chest following surgery, which prevents any fluids from building up in the chest while the tissues heal. It is usually removed at the first postoperative visit. Antibiotic treatment is also used to prevent the development of pneumonia or other chest infections. Restrictions on physical activity (e.g. sports) are usually prescribed for several months following the surgery. 

Finally, surgery for pectus carinatum is a very expensive procedure, typically ranging upwards of $20,000 in cost. The associated costs are not usually covered by health funds, as it will fall under the category of cosmetic appearance treatment in most instances. In contrast, a high-quality chest brace may cost as little as $1,200. Consequently, surgery is only recommended for severe cases of pectus carinatum.

How Bracing With Dakota Brace Solutions Is a Better Option

Non-surgical treatment with a pectus carinatum brace is recommended as the first line of treatment in most patients.[7] This is a compression brace which applies pressure to the protruding region of the breastbone. When worn over an extended period of time (typically 20-22 hours per day for around 6-12 months), this remodels the growth pattern of the breastbone cartilage, helping mold the breastbone into the desired shape.[8]

The amount of compression is begun at a low pressure 2.5-3 PSI) and increased if necessary.[9] Non-surgical treatment generally shows the best results when conducted during the teenage years, while the breastbone cartilage is more flexible and compliant. After the condition has been resolved, the brace only needs to be worn for reduced periods until skeletal growth ceases and the breastbone region begins to harden. 

The results from compression bracing are generally quite good, with <10% of patients failing to respond to treatment. Recurrence is also quite rare. However, the main reason why bracing treatment is not effective is if the brace is not worn as prescribed. This is often due to a poor fit, making the brace quite uncomfortable to wear.

This is where custom pectus carinatum braces from Dakota Brace can help. Each of our braces is custom-built to suit the patient, using a 3D scan of your child’s chest.* The brace is then designed to match your child’s body shape and 3D printed to reduce turn-around times. This ensures a perfect fit while maintaining a high-quality product. All of the steps can be performed remotely,* meaning there are no additional travel costs. We can also work around your schedule for remote consultation sessions. 

Are you 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).

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

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. Abdullah F, Harris J (2016) Pectus excavatum: more than a matter of aesthetics. Pediatr Ann, 45:e403–e406.
4. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
5. Shamberger, R. C. (1996). Congenital chest wall deformities. Current Problems in Surgery, 33(6), 469-542.
6. 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.
7. 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.
8. 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.
9. 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.