Chest wall clinic

Pectus Carinatum is the deformity of the sternum and rib cartilage that causes the chest to protrude outwards (pigeon chest). Pectus Carinatum occurs due to a defect in the costal cartilage that holds the ribs to the breastbone. This defect may be due to excessive growth of the costal cartilages in the rib. This growth causes the ribs and cartilage to force the sternum outwards forming a pointed chest. The deformity is often seen at birth but is more noticeable in childhood during growth spurts when the ribcage is growing and the sternum begins to protrude further. Once fully grown the deformity remains unchanged.

The cause of Pectus Carinatum is unknown. However, the condition is known to run in families suggesting it could be a genetic disorder. As with Pectus Excavatum, it can be associated with other conditions such as scoliosis and homocystinuria as well as inherited connective tissue disorders such as Marfan Syndrome, Ehlers-Danlos Syndrome and Poland’s Syndrome. 

Pectus Carinatum is usually symptomless however it is not uncommon for people to be affected by the deformity. The most common symptom is pain. This can be general chest pain or pain as a result of moving awkwardly or impact during physical activity. You may also experience tenderness and intermittent pain near the overgrown cartilage.

Although internal organs develop normally, the deformity is also associated with breathlessness on exertion or exercise and may be related to the abnormal shape of the chest wall.

It is more common for people, especially children, to suffer from psychological problems associated with a pectus deformity such as a negative self-image resulting in a lack of self-esteem and confidence.

Chest deformities require time to correct and heal so it is important you receive a complete service throughout your treatment. At Spire St Anthony’s we have dedicated before and after teams to provide a comprehensive evaluation and treatment for those affected by Pectus deformities. After an initial consultation with Mr Hunt, an experienced Thoracic Surgeon, we will assess the most appropriate treatment methods for you. Whether it be invasive or non-invasive, we ensure your treatment will be of the highest quality, tailored to your individual needs. For many, a custom-made brace will suffice in restoring the ribcage back to its normal shape however for more severe cases, surgery may be required.

Custom-made brace

A bracing system is considered the first line of treatment in patients with pliable pectus carinatum deformities and is the preferred method to reshape the chest wall. A slim line, lightweight custom-made brace is fitted applying pressure to the ribcage pushing the breastbone back into its normal position. The brace is customised to fit each person for maximum comfort and effectiveness. The brace allows unrestricted arm motion and can be worn during physical activities. For the brace to be effective it must be worn every day for three months and following a prescribed weaning schedule’s typically worn for 9-12 months depending on the age and severity of the patient. Most patients, by six months are only wearing the brace at night.

For further information and common questions visit the Pectus bracing clinic for treatment of Pigeon Chest at Spire St Anthony’s Hospital.

Surgery

Surgery is usually only required for complex cases or in older patients where a brace may not be appropriate in correcting the deformity. Our surgeons use minimally invasive techniques which reduces scarring and recovery time meaning patients can return to regular activities as quickly as possible.

Before deciding whether surgery is right for you, it is vital you seek the opinion of an experienced thoracic surgeon for a consultation. A consultation at St Anthony’s will consist of a thorough evaluation by an experienced thoracic surgeon who will diagnose and advise the most appropriate treatment for you.

Pectus Excavatum or sunken chest is most likely caused by abnormal growth of the costal cartilage junction between the ribs and sternum. This growth causes the ribs and cartilage to force the sternum inwards forming a sunken or funnel chest.

It can present in toddlers but typically becomes apparent during the growth spurt and puberty. Once fully grown the deformity remains unchanged.

The cause of Pectus Excavatum is unknown. However, the condition is known to run in families suggesting it could be a genetic disorder. As with Pectus Carinatum, it can be associated with other conditions such as scoliosis and homocystinuria as well as inherited connective tissue disorders such as Marfan Syndrome, Ehlers-Danlos Syndrome and Poland’s Syndrome.

Pectus Excavatum can cause a variable number and severity of symptoms and its common for you to be affected by the deformity. The most common symptom is pain which usually affects the chest and back and is probably musculoskeletal in origin. You may also experience tenderness and intermittent pain near the overgrown cartilage.

Another common symptom is breathlessness on exertion or exercise and may be related to the abnormal shape of the chest wall. Patients often complain of a feeling of constriction.

In severe Pectus Excavatum the heart and lungs are compressed and may show abnormal function and may even cause symptoms of feeling faint or actually fainting particularly during exercise. It is more common for people, especially children, to suffer from psychological problems associated with a pectus deformity such as a negative self-image resulting in a lack of self-esteem and confidence.

Chest deformities require time to correct and heal so it is important you receive a complete service throughout your treatment. At Spire St Anthony’s we have dedicated before and after teams to provide a comprehensive evaluation and treatment for those affected by Pectus deformities. After an initial consultation with Mr Hunt, an experienced Thoracic Surgeon, we will assess the most appropriate treatment methods for you. Whether it be invasive or non-invasive, we ensure your treatment will be of the highest quality, tailored to your individual needs. Generally, in patients with Pectus Excavatum, treatment in older children and in adults requires surgery. In young children, following careful assessment they may be a candidate for the Vacuum Bell, a non-surgical technique to pull the breast bone back in to normal position.

Vacuum Bell

Though the treatment is still a little controversial, the use of a custom fitted Vacuum Bell to ‘draw’ the sternum forward can be offered in mild Pectus Excavatum in young patients. It is worn regularly and increasingly for 9-12 months under careful medical supervision.

Prosthetic implants

Prosthetic or pectus implants allow a minor non-chest wall corrective cosmetic treatment of most forms of pectus excavatum. The implants are placed in front of the breast bone under the skin, soft tissues and muscle to mask the sunken appearance of the chest. With modern 3D technology and ‘printing’ the implant can be custom built to correct the deformity perfectly. Because the surgery does not alter the bony chest wall it is a minor operation with a short recovery and return to normal activity.

Surgery

Surgery remains an important option in treating and correcting pectus deformities. Several types of corrective operations are available and it's important that your surgeon is familiar with the different surgical options so that the type and severity of the pectus problem can be treated with the best approach safely and effectively.

Choice of operations include a ‘keyhole’ operation known as the Nuss or Minimally Invasive Repair of Pectus Excavatum (MIRPE). It involves placing a metal bar behind the breast bone which then ‘braces’ the breast bone forward to correct the Pectus Excavatum.

Alternatively, an open operation (sometimes known as a Ravitch procedure) involves a ‘break and re-set’ type of approach through a cut over the breast bone or under the breast. The abnormal cartilage part of the chest is cut and partially removed and the breast bone is lifted forward.