What is Pectus Carinatum?

Pectus Carinatum is a condition where the child’s chest wall sticks out more than usual. It is often called pigeon chest due to the bird-like appearance of the breastbone. The deformity occurs more in males than females, and often times is not noticed until the child has a big growth spurt in their early teens.  There are usually no other symptoms besides the way it looks, however, some kids may experience shortness of breath during strenuous activities or pain. The biggest affect can come in the form of depression and social anxiety caused by teasing from their peers. This can cause low self-esteem and an unhealthy self-image.  While the main cause of Pectus Carinatum is unkown, the condition tends to recur in families suggesting that genetics may be a factor. During growth, the cartilage of the breastbone and ribs can become structurally abnormal and overgrown. Other associated connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome are also linked to the deformity.

Photo Courtesy of Protosthetics

Photo Courtesy of Protosthetics

Treatment of Pectus Carinatum

Once the patient is diagnosed by their physician they will be referred to us for an evaluation for a custom brace. More than 95% of cases can be treated non-operatively with the use of a brace as long as the device is worn as prescribed. While the child’s bones are still growing, a custom brace can be worn for 23 hours a day under their clothing. We use a 3D scanning system to capture a model of the torso and measurements are taken. The child gets to pick the color of the plastic and foam to truly customize it to their liking! From there, a 3D printed custom brace is fabricated and delivered within 2 weeks from our scanning appointment. The brace is adjusted with straps on the sides until optimal pressure has been reached. Throughout the treatment, the pressure will gradually be increased as the deformity reduces. The only times when the brace should be removed is during strenuous activities and bathing. A break-in schedule should also be followed to make sure the device is fitting correctly and the child can tolerate the pressure.​  Throughout the treatment, we will follow up with patients to monitor their progress. Appointments are set up 2 weeks after delivery, 3 months, 6 months and 1 year. Additional appointments may be necessary if there is any irritation or anything on the device breaks. 

Brace Wear Schedule

• Day 1: 1-2 hrs
  
• Day 2: 2-3 hrs
  
• Day 3: 3-4 hrs
  
• Day 4: 4-5 hrs
• Day 5: 6-7 hrs
  
• Day 6: 8+ hrs (try sleeping in brace)
  
• Day 7: 10-12 hrs
  
• Day 8: 12-14 hrs
• Day 9: 14-16 hrs 
• Day 10: 16-18 hrs 
• Day 11: 18-20 hrs 
• Day 12: 20-22 hrs 
• Day 13: 23-24 hrs

Clinical Outcomes

In a study published by the Journal of Laparoendoscopic & Advanced Surgical Techniques in June of 2019, outcomes were analyzed following the use of dynamic compression bracing for pectus carinatum.  Results: Of 460 PC patients, 144 reached the retainer mode. Median time to retainer mode was 5.5 months. There was no statistically significant relationship between initial correction pressure or carinatum height and time to retainer mode (P = .08 and P = .10, respectively). Fifty-seven percent were compliant with brace use, and median time to retainer mode in this subset was significantly shorter than noncompliant patients (3.5 months versus 10 months, P < .001). Fifty-three percent responded to the survey 13 months [interquartile ratios 3, 33] after the last clinic visit. The main barrier to compliance with wearing the brace was discomfort (37%), while the main motivation for compliance was appearance (58%). All endorsed bracing as worthwhile, with 94% reporting a satisfaction rating of 8 or greater for the correction outcome.  Conclusion: DCB is effective in achieving correction of PC in compliant patients. Regardless of time to retainer mode, patients reported high satisfaction with bracing.

Journal of Laparoendoscopic & Advanced Surgical Techniques.  Charlene Dekonenko, Robert M. Dorman, Amy Pierce, Beth A. Orrick, David Juang, Pablo Aguayo, Jason D. Fraser, Tolulope A. Oyetunji, Charles L. Snyder, Shawn D. St. Peter, and George W. Holcomb III.Journal of Laparoendoscopic & Advanced Surgical Techniques .http://doi.org/10.1089/lap.2019.0171