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Pectus Carinatum

What is pectus carinatum?

Pectus carinatum (PECK-tuss care-uh-NAW-tum) is when the breastbone (sternum) and the rib cartilage stick out from your baby’s chest. It is also called pigeon breast because it can create a bird-like look. It may be mild, moderate or severe.

Who gets pectus carinatum?

This condition affects about 1 in 1,500 children. It’s more common in boys than girls. It can run in families, but most often only one person in a family is affected. It is caused by a developmental defect in the cartilage that holds the ribs to the breastbone. This cartilage flares out away from the chest and causes the breastbone to stick out. The opposite condition, called pectus excavatum, can also occur. In pectus excavatum, the cartilage grows inward and pushes the breastbone in.

You may notice that the breastbone sticks out from your child’s chest as a baby, or it may not show until later in life. The defect may become more noticeable as your child grows, especially during growth spurts. The problem with the cartilages is often the same on both sides (symmetric). But some children have the problem only on one side or even only in one spot in the chest. This may happen if only a few of the cartilages form abnormally.

What are the symptoms?

Your child may have no symptoms at all and may not need any treatment. The most common symptom is pain, especially if the breastbone is squeezed or hit when the child takes part in sports activities.

How do you diagnose pectus carinatum?

The doctor will examine your child and will ask for a detailed history of any symptoms your child has. A physical examination may be all that the doctor needs to make a diagnosis.

What is your experience with pectus carinatum at Children’s?

We treat many children with pectus carinatum at Children's — several dozen every year. Many of these children need no treatment, and many do not need surgery. Frequently we use a pressure brace that your child wears to slowly reshape their chest. It works in the same way that braces work to move teeth. Gentle constant pressure on the breastbone pushes it back into its normal position. Over time the bone and cartilage heal and stay in this position. For children who do need an operation, our surgeons have extensive experience at performing the procedure they need.

When you come to Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, child life specialists, social workers and others. We work together to meet all of your child’s health needs and help your family through this experience.

Since 1907, Children’s has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give our patients anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.

How do you treat pectus carinatum?

Some children with pectus carinatum need no treatment at all. Of those who can benefit from treatment, many need only a pressure brace. Some need surgery.

Pressure brace

Your child may need to wear a pressure brace for as little as seven hours out of each day for several months. Depending on the severity of the problem, your child may need to wear the brace longer each day and for up to a year. The doctor will check your child’s chest regularly as it moves under the brace’s pressure and will adjust the brace. Eventually, your child will no longer need to wear it.

Surgery

For children who need more than a brace, we perform an operation to move the sternum. This is done through an incision in the chest. The cartilages that push the sternum forward are removed, but the membranes that surround the cartilages are left. The sternum is cut so that it will lie flat. Then the cartilage membranes are sewn into a normal position. Cartilage will re-grow from these membranes. At the time of surgery, your child will have general anesthesia. This means we will give your child medicine to make them sleep without pain during the surgery.

The surgery takes about 2 to 6 hours depending on how many cartilages have to be removed. Your child will be in the recovery room for another hour. We will give your child pain medicine to make them comfortable. You can expect your child to be in the hospital for about one to seven days depending on the severity of the condition and how much had to be done in the operating room.

After surgery

After your child goes home, you’ll need to keep the incision clean and dry until it heals. The surgery team will teach you how to care for the incision and how to give your child pain medicine at home. Another important part of home care is limiting your child’s activity while they recover. For example, your child should sit up straight without slouching for the first month. They should not lift anything heavy for a few months, and they should not take part in some kinds of sports for about six months. The surgery team will explain these and other limits before your child goes home. Some of these limits depend on the severity of the condition and extent of the surgery.

About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.

Resources

Read more about what to expect when your child visits a clinic at Children's, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child's care team. You can also take a virtual tour of our surgery rooms and other parts of the hospital.

To learn more about this condition, you may want to visit our resource list.