Pigeon chest

What is a pectus carinatum?

A pectus carinatum, also called a pigeon chest, refers to an anatomical change in which the sternum protrudes forward in a keel shape. It is presumed to be due to excessive growth of the cartilage on the sternum and is significantly more common in males. People affected usually have no medical complaints or limitations, although the aesthetics, particularly during puberty, can be perceived as very distressing.

Why does a pectus carinatum develop?

The exact origin of a pectus carinatum is not yet clear, but it appears to be at least partially genetic like some of the other chest wall deformities. Most patients first develop a pectus carinatum after the age of 11, due to the rapid growth of the cartilage in the upper pairs of ribs.

Are there physical limitations due to pectus carinatum?

Only very severe chest deformities are likely to cause physical limitations. Contrary to pectus excavatum, where the curvature of the sternum towards the chest can impede the expansion of the lungs and heart, a pectus carinatum can often lead to an enlarged chest cavity. As a result, patients with pectus carinatum are more likely to suffer from psychological stress and discontentment with their physical appearance leading to difficulties in everyday life, especially during puberty.

How is a pectus carinatum treated?

In most cases, no treatment is necessary for a pectus carinatum as from a medical perspective it is considered a harmless deformity. It can, however, be corrected for aesthetic purposes. There are different approaches for the correction. This includes conservative therapy - i.e. therapy without surgical intervention - or surgical therapy. The treatment of choice depends on a variety of factors such as the age of the patient or the severity of the malformation. The most common treatment methods are described in more detail below.

Compression therapy

Compression therapy is a conservative method for treating pectus carinatum. It involves exerting external pressure on the chest and ribcage by means of a type of corset (also known as "orthosis" or "brace" medically) with the aim of reshaping the chest to a normal shape. This method is best suited for younger patients, particularly during puberty, as bone growth is not yet fully complete and so the bones are still considered malleable. Although the pressure of the orthosis can be individually adjusted, daily wear is necessary for the therapy to be successful. It is possible for patients to experience some pressure pain, back pain, and skin irritation during treatment. If worn consistently, results are visible within 6 to 9 months.

Minimally invasive repair of pectus carinatum

Minimally invasive correction of the pectus carinatum is a relatively new treatment method and is still not offered in every clinic in Germany. Here, a metal bar is placed under the sternum to bend it inwards. The pectus carinatum is already visually corrected immediately after the operation. The metal bar is surgically removed after about two years as the chest wall is considered stable after this period. Even though minimally invasive correction of the pectus carinatum is still a surgical procedure, it has a quicker healing period and results in significantly smaller scars than an open correction.

Open corrective surgery according to Ravitch

Open correction of the chest can be done in particularly severe cases of pectus carinatum or if the compression therapy has not been successful. This involves opening the ribcage during surgery, removing the deformed rib cartilage and, if necessary, cutting through the sternum. Then, the ribs are secured to the sternum in the corrected position with metal implants, and the chest is closed again. The implants are then removed after about 6 to 12 months in a second procedure. After the operation, physiotherapy is necessary, and visible scarring is to be expected.

When should a pectus carinatum be treated?

When to start treatment is determined individually. Whereas compression therapy is most successful at a young age, ideally during puberty, surgical interventions can be performed at a later stage. Should a pectus carinatum become visible before puberty, it is advised to first observe the growth of the affected person and to get information on the necessity and timing of treatment as part of regular medical check-ups.

Which doctors and clinics specialize in pectus carinatum correction?

An initial consultation is generally done with a pediatrician. Where necessary, a referral to a pediatric surgeon is made and further information is given in a clinic with a department for pediatric surgery. Treatment of adults begins with the general practitioner and a referral is made to a thoracic surgeon.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of pectus carinatum. They are looking forward to and are ready to address your questions and treatment requests.