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 carinaPectus Carinatum Repair Homecaretum 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.
What does the surgery involve?
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.