General and Thoracic Surgery Pectus Carinatum
General and Thoracic Surgery Pectus Carinatum

Pectus carinatum is a common pediatric condition characterized by an abnormal overgrowth of the rib cartilages, which results in protrusion of the breastbone (sternum) and rib cartilages. This condition is observed more frequently in males than in females (4:1 ratio).

The cause of PC is unknown; however, it may be genetically linked considering its frequent occurrence in families.

What are the symptoms?

Many people with pectus carinatum will have shortness of breath with activity, decreased endurance or chest pain. Some children and their parents report that the children feel embarrassed about the appearance of their chest.

How is it fixed?

Bracing is the treatment of choice for pectus carinatum because the chest is still compliant (flexible) during childhood and adolescence.

The brace used at Children's Mercy Hospitals and Clinics, called the dynamic compression device (DCD), is the newest brace available and is on the cutting edge of treatment for pectus carinatum. It corrects the abnormal chest shape and allows remodeling by applying external compression (similar to the way braces correct crooked teeth).

The pectus brace uses the least amount of pressure needed to fix the chest in order to maximize comfort. It will be adjusted (tightened) every few months until the chest has a normal appearance.

What does the brace look like?

The brace has a number of screws that are needed to make bracing adjustments. These screws may need to be tightened once a week. Only the black screws should be tightened. You can do this at home using a manual screwdriver. The silver screws that hold the front compression plate in place should not be manipulated.

How long does the brace need to be worn?

We recommend that the brace be worn as much as possible (23 out of 24 hours a day) every day for optimal correction. The brace only works when it is worn as prescribed. Wearing the brace as often as possible throughout the day and night (excluding showers and sports) will allow the best correction outcome.

The typical length of time needed to wear the brace for full correction will vary from person to person. On average, the brace will need to be worn for six-to-20 months. After the chest becomes a more normal shape, the brace will still need to be worn less often in "retainer mode."

During brace therapy, your child will be taught exercises by our physical therapist. Completing these exercises daily will strengthen the chest and optimize brace therapy.

Is the brace noticeable?

The brace can easily be worn under clothes. Some prefer to wear a thin, tightly-fitting shirt under the brace for comfort.

Does the brace hurt? What are the side effects?

 

  • Most children say their chest is slightly sore after the initial brace fitting. This can be treated with ibuprofen (Motrin) or acetaminophen (Tylenol).
  • Your child may experience slight redness and pain on the front of the chest from the brace. This is normal.
  • If the brace causes a scratch or sore that is open, this is not normal and the brace should be removed.
  • If you remove the brace and the reddened area on the chest does not "blanche," you need to remove the brace and call the office. Blanching is when you press on the red area and it temporarily turns white and then back to red. Do not put the brace back on until the reddened area can blanche.
  • If the problem continues, the child should not replace the brace until he/she can be seen in the clinic for adjustments.
  • If your child has trouble sleeping with the brace on, try using memory foam or a similar-type padding over the mattress.
  • Girls should not use the brace with an underwire bra as this may cause pain and skin breakdown.
  • If you have questions or concerns about the brace, please call the Surgery Clinic: South (913) 696-8570 or Downtown (816) 234-3199

What if the brace doesn't work?

If your child has been compliant wearing the brace (wearing it as often as possible, as prescribed), and has been trying it for about two years, we may consider surgery to correct his/her pectus carinatum.

Surgery involves reshaping/removing the abnormal rib cartilages while preserving their outer layer, allowing new cartilage to grow. The breastbone may also need to be revised and/or repositioned. An incision is made in the center of the chest to repair this abnormality. Post-operative drains (soft, flexible tubes) will be in place for three-to-six days and will be removed when the drainage decreases.

Children are usually hospitalized for three-to-five days and would have strict activity restrictions for two-to-three months following surgery.

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