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What is pectus carinatum?


Pectus (Latin: ‘chest’) carinatum (Latin: ‘keel’) is a deformity of the chest which causes the breastbone (sternum) to be pushed out. The condition is also known as ‘pigeon chest’ or ‘chicken breast’. It is less common than pectus excavatum, in which the sternum is pushed in or depressed. The prevalence is thought to be about 1 in 2,000 in the US population.

Researchers have not identified pectus carinatum causes, but it likely has a genetic component since as many as 1 in 4 patients have a family history of other affected relative. Pectus deformity occurs more frequently in males than females (4:1 ratio).

The pectus team at Children’s Mercy Kansas City are recognized leaders in treating chest wall deformities, and are one of the highest volume centers in the country. 

Pectus Carinatum at Children's Mercy

Common questions from patients and families about pectus carinatum

Children with pectus carinatum may have no symptoms other than the outward appearance caused by the condition. Some will have shortness of breath when active (such as during sports), as well as decreased stamina. Some patients have chest pain. One of the more common problems associated with pectus carinatum is psychosocial. Children are often highly embarrassed about the appearance of their chest, and may avoid activities or social interaction for these reasons. 

In mild cases without symptoms, no treatment may be necessary. In very severe cases, or those with unusual anatomy, operation to remove abnormal rib cartilages may be recommended. However, a need for operation is rare. Bracing has become the preferred treatment for most children. Excellent outcomes can often be obtained without surgery.

Wearing a chest brace for pectus carinatum is an effective treatment because children’s growing bodies are very flexible during childhood and adolescence. That adaptability means children’s chests can more easily be molded into the correct shape as they grow.

The pectus team at Children’s Mercy use a pectus brace that is particularly effective in treating the condition in adolescence, and is usually applied during adolescence. The brace, or dynamic compression device (DCD) is considered a cutting-edge pectus carinatum treatment. This state-of-the-art brace corrects an abnormal chest shape the way orthodontics corrects crooked teeth. It “remodels” the chest by applying gentle pressure to gradually correct the area of protrusion. Worn continuously and adjusted regularly (typically every other month) the brace allows the chest to slowly redevelop into a more normal shape.

The brace is made out of a light-weight aluminum that is worn around the chest. It provides pressure from both the front and back to direct the breastbone to neutral position. There are cushioned pads that contact the child’s chest. The main pad is positioned to press against the breastbone. The band is adjustable.

When a child first begins wearing the brace, he or she should do so for as many hours of the day as possible (23 out of 24 hours a day). Except for during bathing and sports, your child should wear the brace all day and also during the night. (You can download a sheet of tips on wearing a brace as a helpful reminder of dos and don’ts.)

Most children will need to wear the brace full time for about six to 20 months, though that period can vary. After the chest develops a more normal shape, your child can reduce the amount of time that he or she wears the brace, much like you wear a dental retainer after orthodontic braces are removed.

Under normal, loose-fitting clothing, the brace is not easily noticeable. 

No, the brace should not be painful to wear. Most children say their chest is slightly sore after they first begin wearing the brace, especially on the front of the chest, but ibuprofen (Motrin) or acetaminophen (Tylenol) can ease the discomfort. Minimal redness at the contact sites from wearing the brace is normal. Some patients prefer to wear a thin, tightly-fitting, moisture-wicking shirt underneath.

If your child has been consistently wearing the brace for about two years, but the condition has not dramatically improved, then doctors may recommend pectus carinatum surgery to correct it. This is uncommon.
Surgery involves removing the abnormal rib cartilages and sometimes altering the sternum (breastbone). The operation to repair severe or refractory carinatum takes about 2-3 hours, and a hospital stay of 4-6 days. The results are generally excellent. 

If you have questions or concerns about this condition and its treatment, please call the Surgery Clinic: Children's Mercy Kansas at (913) 696-8570 or the Adele campus at (816) 234-3199.

If you are concerned about insurance coverage or pectus carinatum brace cost, Children’s Mercy’s health specialists can provide details.

The estimate of prices and traditional charges for professional service are listed on the Pectus Brace billing page. Every child is different; therefore, there may be services outside of the pricing performed at the time of service and are not included in this summary.

Stories

Pectus Carinatum: Weston's Story

At 15, Weston Marshall was diagnosed with a protruding sternum, called pectus carinatum. The Center for Pectus Excavatum and Pectus Carinatum at Children’s Mercy used a special brace to correct the condition.

Meet Weston

Pectus Carinatum: Zane's Story

A “bump” in the center of Zane Johnson’s chest called pectus carinatum brought him to the Center for Pectus Excavatum and Pectus Carinatum at Children’s Mercy. A special brace is correcting the condition.

Meet Zane

Billing for a Pectus Brace

Once your child has been identified as a pectus brace candidate, the clinical team will reach out to the Children’s Mercy Pre-Certification department to pursue at Pre-Authorization or Pre-Determination to determine if your insurance company will cover this service.