Treatment of Pectus Carinatum (Pigeon Chest)

Treatment of Pectus Carinatum (Pigeon Chest)

Pectus Carinatum, commonly known as pigeon chest, is the second most frequently occurring chest wall deformity after pectus excavatum. It is characterized by abnormal growth in the cartilage structure of the ribs located between the rib cage and sternum. The sternum is commonly referred to as the breastbone.

It appears as a pronounced protrusion on the chest wall. Generally, it occurs in the costal cartilages of the breastbone. In some patients, it develops bilaterally, while in others it is unilateral.

Abnormal cartilage growths causing pigeon chest typically appear during adolescence, most commonly between ages 11-15 in children. This condition is more frequently observed in males.

What Are the Symptoms of Pigeon Chest?

• The individual may experience chest pain or shortness of breath related to physical activity.
• When lying face down, the person may experience chest pain or develop sensitivity in the chest area.
• Approximately 1 in 4 individuals may exhibit asthma-like symptoms.
• The person may be negatively affected psychologically due to this unusual appearance.
• Lung-related complaints may develop.
• While this condition does not have clearly defined extensive symptoms, research on this topic continues.

What Are the Types of Pectus Carinatum?

Pectus carinatum is a relatively common condition characterized by the breastbone (sternum) protruding more than normal. Its severity can range from mild to severe. In mild cases, the sternal protrusion is barely noticeable, while in advanced cases, the protrusion may be significant enough to affect breathing and cardiac function.

There are two main types of pectus carinatum:

• Chondrogladiolar Pectus Carinatum: The most common type. It results from abnormal growth of the cartilage tissue that connects the ribs to the sternum.
• Chondromanubrial Pectus Carinatum: A less common type. It results from abnormal growth of the cartilage tissue connecting the sternum to the ribs.

In some cases, pectus carinatum may result from a combination of genetic and environmental factors.

How Is Pectus Carinatum Diagnosed?

Pectus carinatum can be initially assessed through physical examination. The doctor examines the chest and evaluates the characteristic outward protrusion of the sternum. Additional tests such as chest X-ray or computed tomography (CT) may be requested to rule out other conditions.

Some tests that can be used in the diagnostic process include:

• Chest X-ray (Radiography): A simple and painless examination that can show the shape of the chest and the size of the sternal protrusion.
• Computed Tomography (CT): A more detailed imaging method that provides more comprehensive information about chest structure.
• Echocardiography: This test, which uses sound waves to visualize the heart, can be used to evaluate possible cardiac issues associated with pectus carinatum.

It is important to consult a doctor upon noticing complaints and symptoms for an accurate evaluation and determination of appropriate treatment options.

What Are the Treatment Methods for Pigeon Chest?

Pigeon chest is not a commonly seen condition. However, since it becomes apparent during early adolescence, it is a condition that can be addressed with treatment. This condition is managed according to the severity of the case and the patient's circumstances. Treatment is performed in two ways: surgical intervention and orthotic bracing.

Surgical Treatment: In this treatment, patients may undergo modified Ravitch surgery. An incision is made in the affected chest area. The abnormally grown cartilage is removed and the chest wall is repositioned. In some cases, the surgeon may temporarily place a metal bar across the chest if deemed necessary.

Following this surgery, which may be accompanied by significant pain, hospitalization duration is planned according to the patient's condition. The pain present in the patient may also alter this hospitalization period.

Another surgical method is Abramson Surgery. During this operation, large incisions are not made to the chest; instead, the procedure is performed through small incisions. This surgery typically lasts 30-45 minutes depending on the patient's condition and is performed under general anesthesia.

After this surgical procedure, the hospital stay is typically 4-5 days but may vary depending on the patient's condition. The person should avoid sudden movements. After 2-3 weeks, with the doctor's approval, the patient can return to normal activities. If the patient is a child, they can return to school after 2-3 weeks with the doctor's approval.

Orthotic Bracing Treatment: Another option is orthotic bracing treatment. The brace fitted to the patient applies pressure to the ribs from behind and to the breastbone from the front, aiming to support the chest toward a more typical position.

The patient is generally advised to wear the brace for 18-20 hours daily for around 2 years, as recommended by the treating physician. As recommended by doctors, it should only be removed during bathing and sports. Unless otherwise instructed, the patient should follow the doctor's instructions closely.

How Does the Post-Operative Recovery Process Progress?

Recovery time varies from person to person depending on various factors. The generally expected process is as follows:

• Immediate Post-Operative Days: The patient remains hospitalized for several days immediately after surgery for observation and pain management. During this period, pain, swelling, and discomfort may be experienced.
• First Weeks: In the weeks following surgery, mobility gradually returns and pain may begin to decrease. The surgeon guides the patient regarding care of the surgical site and management of discomfort.
• First Month: By the end of the first month, some patients may return to low-intensity activities such as walking and gentle stretching. Surgeon's recommendations should be carefully followed to help reduce the risk of complications.
• 3-6 Months: Within three to six months after surgery, many individuals are able to return to moderate-level physical activities. Adherence to a rehabilitation plan established by the surgeon or physiotherapist may support the recovery process.
• 6-12 Months: Recovery generally continues over six to twelve months following surgery. During this period, strength and flexibility in the chest area may gradually return, and surgical scars often become less noticeable over time.

Does Pigeon Chest Grow?

Although pigeon chest is congenital, it manifests itself at younger ages as well. This condition, generally observed in children, tends to change along with the child since bone development and growth in children are incomplete.

Surgery can technically be performed at ages 1-2, but it is generally not recommended at that age. Surgery is more commonly performed during adolescence or at earlier stages such as ages 7-8, based on the physician's evaluation.

Does Pigeon Chest Resolve Spontaneously and Does It Worsen With Age?

Pectus carinatum is a congenital condition, particularly noted during childhood and adolescence. During these periods, in some cases, the chest wall may naturally reshape with the body's growth and development, and the prominence of the protrusion may decrease. However, this spontaneous change does not occur in every patient, and the severity of the condition varies from person to person.

Generally, pectus carinatum does not typically worsen with age; in some patients, the protrusion remains stable throughout adulthood without causing significant health problems. Conversely, in some patients, particularly if left untreated, the deformity may become more prominent over time.

If the chest protrusion causes physical discomfort or psychological distress, consultation with a doctor is recommended. Due to greater chest wall flexibility during childhood, early evaluation and intervention are often considered to allow for more options.

Exercises for Pigeon Chest

If pigeon chest is not in an advanced stage, some improvement with exercise may be possible depending on the individual case. However, if its appearance and symptoms are advanced, surgical intervention under medical supervision may be considered.

Following surgical operation, it is recommended that the patient maintain contact with the doctor and avoid any sports or activities contrary to medical advice.

Orthotic Bracing Treatment for Pigeon Chest

Although pigeon chest patients may require surgical operation, in some cases the doctor does not recommend it and initiates orthotic bracing treatment instead. Particularly in children whose bone development is incomplete, if the disorder is not advanced, treatment may be started with an orthosis, a type of brace.

The purpose of using this brace in children is to support the flexible, still-developing bone structure toward a more typical shape.

The orthosis is an apparatus that applies pressure to the ribs from behind and to the breastbone area from the front, supporting the chest toward its typical shape. This apparatus is readjusted by the doctor every 4-6 weeks to continue the chest's reshaping process.

What Causes Pigeon Chest?

Although the exact cause of pectus carinatum is not fully understood, it is believed that multiple factors play a role in its development.

One of the main causes of pigeon chest is abnormal growth of the cartilage tissue that connects the ribs to the breastbone. This abnormal growth can lead to the breastbone being pushed outward and the chest assuming a protruding shape. Genetic factors may also play a role in the development of pectus carinatum; the condition tends to run in families.

Other factors that may contribute to the condition include certain medical conditions such as Marfan syndrome, scoliosis, and rickets. Additionally, poor posture during childhood and adolescence, such as slouching or forward-bending posture, can create pressure on the chest and contribute to pigeon chest development.

Although pigeon chest generally does not cause serious health damage and is usually not painful, it can lead to self-confidence issues and, in advanced cases, may affect lung and cardiac function.

In conclusion, although the exact cause of pigeon chest is not fully understood, it is believed that a combination of genetic and environmental factors, along with abnormal growth in cartilage tissue, contributes to this condition.

What Are Possible Complications of Pectus Carinatum?

In most cases, pectus carinatum does not lead to serious complications. However, in some situations the following may occur:

• Shortness of Breath: The protrusion on the sternum may create pressure on the lungs and make breathing difficult.
• Chest Pain: The sternal protrusion may also create pressure on the heart, causing chest pain.
• Self-Confidence Issues: Pectus carinatum can lead to self-confidence problems due to the individual's discomfort with their appearance.
• Cardiac Problems: In rare cases, pectus carinatum may be associated with cardiac issues such as arrhythmia and heart failure.

Risks of Pigeon Chest

Generally, if it does not cause troubling symptoms, it does not pose a serious health risk. However, since it is particularly observed in adolescent children, it can cause significant psychological difficulty at that age. For this reason, many individuals seek treatment.

This condition, evaluated and treated under the supervision of a thoracic surgery specialist, may respond well to treatment when addressed in early childhood before bone development is complete; outcomes can vary depending on the individual case, and your physician can provide guidance specific to your situation.

Is It Possible to Prevent Pectus Carinatum?

Pectus carinatum is typically a congenital condition that results from the shaping of the chest wall during fetal development. Therefore, since this condition is largely determined by genetic factors and influences beyond our control, there is no established method to prevent it.

Research shows that genetic factors play an important role in the development of pectus carinatum. In individuals with a family history of chest wall deformity, the likelihood of developing this condition may be higher. Since it is not possible to alter genetic predisposition, prevention options are limited.

The most effective approach at this point is early detection of the condition and initiation of appropriate monitoring and evaluation processes, in consultation with a physician.

How Does Life Shape After Surgery?

Psychological and Emotional Adjustment: The post-operative period following pectus carinatum surgery is not limited to physical recovery; it also encompasses psychological and emotional adjustment. Some individuals report changes in self-confidence and body image perception following surgery, though outcomes vary from person to person. It should be remembered that this emotional process may progress differently in each person. Patients experiencing persistent emotional concerns or body image-related issues may benefit from consulting with counseling services and support groups.

Physical Activity and Lifestyle: Surgery can affect a person's physical capacity and overall lifestyle, though individual results vary. Some individuals report being able to breathe more comfortably and participate in physical activities with fewer restrictions related to the chest deformity. Regular exercise, particularly movements that strengthen the chest area, may help support the recovery process and overall health; this should be discussed with your physician.

Follow-up Care: Continued regular check-ups are important for monitoring the recovery process and early detection of any potential issues. The surgeon schedules follow-up appointments to assess healing; patients with surgical scars may also receive guidance on scar care.

Pigeon Chest Treatment in Turkey

Pectus Carinatum, or pigeon chest, refers to abnormal forward growth of the cartilage structure in the chest area, and treatment of this condition is available in Turkey.

Medical care in Turkey has developed alongside broader technological advances, offering treatment options for many conditions. Since diseases that seriously negat