Related Conditions
Related Physicians
Pectus carinatum (sometimes called "bowed chest"
or "pigeon chest") is a chest wall deformity related to pectus
excavatum caused by an overgrowth of cartilage between the ribs
and the breast bone (sternum). This abnormal cartilage displaces
the sternum forward where pectus excavatum displaces it inward. A
pectus carinatum deformity is a birth defect that may not be
noticeable in early childhood but will become more prominent as the
child grows, particularly during adolescence. The pectus carinatum
deformity varies in severity and symmetry during the lifespan of a
single patient and varies from patient to patient.
- Does my child need surgery?
- What does the surgery involve?
- How long will my child stay in the hospital?
- Homecare after pectus carinatum
Does my child need surgery?
Although there may be some tenderness associated
with the protruding breast bone, in most children this deformity
poses no health risk. An operation is primarily offered for
cosmetic reasons. For some children, the deformity can cause
significant psychological stress and difficulty in socializing with
their peers. Talking with your child honestly and openly about
his/her condition can help determine how s/he really feels about it
and if/how the condition affects his/her well-being.
Are there any alternatives to surgery to treat this condition?
Some alternatives to surgery that have been described include special exercises to either mold the chest or de-emphasize the deformity and wearing a special kind of brace.
Non-surgical Treatment at Orthodonic & Prothetics Center
The Orthotics and Prosthetics Center at UCSF provides a full array of services in orthotics (bracing) and prosthetics (artificial limbs). A complete program of bracing for various chest wall deformities, like pectus carinatum, is included in our orthotics care.
Orthotics & Prosthetics Center Facility
521 Parnassus, Room C-36
Phone: 415-476-1788
Fax: 415-476-7003
Orthotics & Prosthetics Center Facility
accepts a wide variety of insurance coverages, Medi-Cal, and
Medicare. Details of your coverage will be completely clarified by
our administrative staff at your first visit.
For treatment of pectus carinatum, a brief history is obtained, followed by a quick plaster or fiberglass mold.
Once coverage authorization or pre-approval is obtained, we will fabricate the orthosis, usually within one to two weeks. You will then return to pick up the orthosis to ensure a proper fit and function. The first follow up visit is usually scheduled to monitor improvements three months later. Further future visits will be determined at that time.
Surgical Repair of Pectus Carinatum
The extent of the operation is determined by the severity and symmetry of the pectus carinatum. An incision is made across the chest and the deformed cartilages are removed. The sternum can then be placed in the usual, flat position and the incision is closed. The amount of time this operation requires is determined by severity of the deformity, but can take up to four hours or longer.
Over the next weeks to months, the cartilage will regrow with a more normal appearance. The stitches used to close the skin are dissolvable, placed under the skin, and do not need to be removed postoperatively. Your child's incision will be covered by Steri-Strips, gauze, and a clear film dressing by the surgeon at the end of the operation. This dressing is removed two days after the surgery.
Are there any risks associated with the surgery?
The main potential risks associated with surgery are bleeding, infection, and pain. These risks are usually relatively small and are by far outweighed by the benefits of the surgery, which include an improved appearance and overall improved well-being. The risks may vary depending on the severity of the defect; ask your surgeon about your particular case.
How long will my child stay in the hospital?
The pectus carinatum repair is a painful procedure. The length of stay in the hospital is mainly determined by postoperative pain management. Most children are hospitalized between 3 and 5 days. An epidural catheter will be placed in your child's back for continuous administration of pain medication. While the epidural is in place, your child will have a catheter in the bladder to drain urine and may be given oxygen by a small tube under the nose. After 1 or 2 days, pain medication will be started by mouth and the epidural pain infusion will be tapered and then stopped. The bladder catheter is removed several hours after the epidural catheter is removed.
You can help your child's recovery by encouraging deep breathing, sitting in a chair and walking soon after the operation.
Before your child leaves the hospital, the surgeon may order a custom chest brace to be made and worn at home. The orthotics specialist will fit your child for the brace and provide instructions regarding proper use, before you leave the hospital. Your child's surgeon will discuss this with you at the time of the operation.
Repair After Surgery
The pectus carinatum repair is a painful procedure. The length of stay in the hospital is mainly determined by postoperative pain management. You can help your child's recovery by encouraging deep breathing, sitting in a chair and walking soon after the operation.
Before your child leaves the hospital, the surgeon may order a custom chest brace to be made and worn at home. The orthotics specialist will fit your child for the brace and provide instructions regarding proper use, before you leave the hospital. Your child's surgeon will discuss this with you at the time of the operation.
- Pain Management
- Care for Dressings
- Swelling After Surgery
- Bathing Restrictions
- Activity Restrictions
- Do I see the surgeon again after the operation?
Pain Management
Before discharge home a prescription for pain medication will be given to you to take to your local pharmacy. If your pharmacy will be closed by the time you arrive home, you may have your prescription filled at a pharmacy near the hospital. Please talk to the pediatric pharmacist before you leave the hospital to make these arrangements. For some patients, several different medications may be used, for example, Tylenol with codeine alternating with ibuprofen. It is important to follow the pain management protocol prescribed by your surgeon to minimize your child's discomfort.
Care for Dressings
The gauze and clear plastic dressings may be removed two days after surgery. Covering the incision(s) will be white strips of tape called Steri-Strips. There may be a small amount of blood on the Steri-Strips; this is normal. The skin surrounding the incisions may be bruised or slightly swollen; this get better quickly. Your child can bathe with the Steri-Strips in place. They will fall off on their own and do not need to be removed.
In most operations, the wound is closed with dissolvable suture(stitches). These stitches are under the skin and do not have to be removed. In some children these stitches may come through the incision about 4 weeks postoperatively. This may be associated with a little local redness and pus and it may involve an end of the incision or a larger portion. This is normal and is best treated by gently cleansing the area with soap and water and waiting. When the suture falls out or completely dissolves, the wound will heal. If your child has worsening redness, swelling pain of the incision and a fever within 2 weeks of the operation, please call our office.
Swelling After Surgery
There may be a slight amount of swelling around the area of the incision that should get better in a few days. Swelling that does not go away or worsens should be reported to our office. About 3-4 weeks after the operation you may feel a lump under the incision. This is called a healing ridge and is normal. This lump may last for several months before it softens and goes away. At about the same time, in some patients, the dissolvable sutures may come through the incision appearing as little white strings. This is normal and these will fall off on their own. Sometimes there is a little redness where the sutures come through the skin; this is not an infection but irritation that will go away on its own.
Bathing Restrictions
Your child may bathe or shower after the epidural catheter is removed. Once your child is home, he or she may bathe or shower without restriction. Try not to rub off the Steri-Strips; have your child blot them dry when s/he finishes bathing.
Activity Restrictions
Your child will need to avoid contact sports, vigorous exercise, and other activities for which there is the potential for a high-velocity impact, such as bicycling, for 3 months, while your child's chest heals.
Do I see the surgeon again after the operation?
If all is going well, we recommend a visit to our office 2 -4 weeks after the hospital discharge. A visit to your child's pediatrician one to 2 weeks after hospital discharge is also recommended. Call our office at any time if you are worried about your child's recovery. If your child is wearing a brace, he or she will need to return to the orthotics department periodically to assess and adjust the fit of the brace to maximize its effectiveness. We will make every effort to coordinate appointments on the same day.
Call our office at 415-476-2538 for the following:
- Any concerns you have about your child's recovery
- A temperature of 101.5F or higher
- A red incision
- Increasing pain and tenderness of the incision
- Fluid coming out of the incision
- Any difficulty breathing or recurrent chest pains
