Pigeon breast symptoms causes and modern treatment methods

Have you ever noticed an unusual protrusion in your child’s chest—or even your own? This condition is known as Pectus Carinatum, often referred to as “pigeon chest.” It is a chest wall deformity that typically appears during childhood or adolescence. Although it usually doesn’t cause major health problems, its appearance can affect self-confidence.In this Dailly Medical Guide article, we will explore the causes of Pectus Carinatum, its main symptoms, and the latest treatment options, including non-surgical bracing therapy, physical exercises, and surgical correction. You will also learn about the best care and follow-up methods to ensure effective results and improve the chest shape safely.

What Is Pectus Carinatum (Pigeon Chest)?

Pectus Carinatum is a chest wall deformity in which the middle of the chest protrudes outward due to overgrowth of the cartilage between the ribs and the sternum. It’s called “pigeon chest” because its appearance resembles the chest of birds.

Pectus Carinatum affects males more than females and occurs in about 6 out of every 1000 children. It usually becomes noticeable from around age 11 and becomes more pronounced during adolescence. Although the exact cause is still unknown, genetic predisposition plays an important role.

When Does Pectus Carinatum Appear?

Usually appears in early childhood or adolescence.
Becomes more noticeable during periods of rapid growth.

Does Pectus Carinatum Affect Breathing or the Heart?

Most cases do not cause heart or lung problems.
However, in more severe cases, it may cause:

Shortness of breath during exercise
Occasional heart palpitations

Does Pectus Carinatum Get Worse With Age?

During adolescence and rapid growth, the protrusion usually becomes more visible.
After bone growth stops, the deformity typically does not worsen but becomes more permanent.

When Is the Lorenz Bar Removed?

A Lorenz bar is placed surgically to stabilize the chest after correction.

Under 18 years: removed after 2–3 years
Over 18 years: removed after 3–4 years

Removal takes 30–45 minutes under general anesthesia.

Is Pectus Carinatum Present at Birth?

Rarely seen at birth.
Usually appears in early childhood or during adolescence due to uneven cartilage growth.

Can Pectus Carinatum Be Prevented?

No definite way to prevent it, especially if it is hereditary.
Early diagnosis and bracing can significantly reduce severity and improve appearance.

The Relationship Between Pectus Carinatum and Sports

Sports do not cause pigeon chest.
However, physical activity helps:

Strengthen chest and back muscles
Improve posture, which reduces the prominence of the protrusion

Do All Cases Require Surgery?

No.
Most mild to moderate cases are treated with:

Chest compression braces
Exercise therapy

Surgery is reserved for severe cases or those that do not respond to bracing.

How Long Does Bracing Treatment Take?

Typically 6–12 months, depending on severity and response.
Severe or late-diagnosed cases may need longer.

Do Exercises Improve Appearance After Surgery?

Yes.
Exercises help:

Strengthen chest and back muscles
Improve posture and prevent spinal imbalance after surgery

Does Pectus Carinatum Affect Self-Confidence?

Yes, significantly.
Many adolescents feel embarrassed by the chest shape, which may affect:

Social activities
Self-esteem
Psychological well-being

Can Children Wear Compression Braces at School?

Yes.
Braces are designed to be:

Lightweight
Comfortable
Hidden under clothing

Consistency and daily wearing time are essential for best results.

Can Pectus Carinatum Be Linked to Other Conditions?

Rarely, it may be associated with genetic syndromes such as:

Marfan syndrome
Ehlers-Danlos syndrome

A full medical evaluation is recommended if there is family history or other signs.

Stages of Pectus Carinatum

1. Early Stage

Age: Early childhood or beginning of rapid growth
Appearance: Mild, barely noticeable protrusion
Symptoms: Usually none
Importance: Best time for bracing, as the chest is still flexible

2. Progressive Stage

Age: Adolescence
Appearance: Clear chest protrusion, sometimes asymmetric
Symptoms: Mild breathing difficulty during activity, chest pressure or mild pain
Importance: Early intervention prevents worsening

3. Chronic/Severe Stage

Age: After bone maturity (18–20+ years)
Appearance: Fixed, pronounced protrusion even at rest
Symptoms: Noticeable breathing difficulty during exertion, chronic chest discomfort
Importance: Surgery is usually required, as braces are less effective

Causes of Pectus Carinatum

1. Genetic Factors

25–40% of cases have a family history
Linked to genes affecting cartilage and bone growth

2. Abnormal Cartilage Growth

The primary cause is:

Overgrowth or uneven growth of the rib cartilage
This pushes the sternum outward instead of staying flat.

The condition often becomes more visible during puberty.

3. Associated Genetic Syndromes

Includes:

Marfan syndrome: Affects connective tissue and causes chest deformities
Ehlers-Danlos syndrome: Weak connective tissue leads to chest wall abnormalities
Noonan syndrome and other rare genetic conditions

4. Heart or Lung-Related Conditions (Less Common)

In rare cases, the deformity can be secondary to:

Chronic lung conditions
Rare cardiac issues affecting chest development

These are far less common than genetic or cartilage-related causes.

5. Lifestyle or Environmental Factors

These are usually not direct causes, but they may affect the severity of the deformity:

Poor nutrition or deficiency of calcium and vitamin D can reduce bone strength.
Rapid growth during childhood or adolescence can make the chest protrusion more noticeable if there is a genetic predisposition.

6. Factors That Increase Severity

Early or rapid puberty in boys.
Presence of connective tissue or cartilage disorders.
Lack of early treatment or follow-up during childhood, as intervention is easier and more effective before growth stops.

Symptoms of Pectus Carinatum

1. Physical Appearance

Prominent forward protrusion of the chest, usually in the sternum.
Chest may resemble a “pigeon chest”: either the upper and lower halves of the chest are both prominent, or the whole chest protrudes.
Asymmetry between the two sides of the chest may occur.
Skin over the protrusion may appear tight or raised.
Occasionally, lateral cartilage bumps appear as small nodules.

2. Physical Symptoms

Most cases do not cause serious health problems.
Some individuals may experience:
Mild difficulty breathing during exertion or exercise.
Mild chest discomfort or pressure when touching the chest.
Difficulty taking a deep breath, especially during physical activity.

3. Psychological and Social Symptoms

Due to the chest’s prominent appearance, children and adolescents may experience:

Embarrassment in front of peers or when changing clothes.
Low self-confidence.
Avoidance of sports or swimming for fear of exposing the chest.

4. Symptoms in Severe Cases (Rare)

Rapid heartbeat or palpitations due to chest pressure on the heart.
Noticeable breathing difficulties during exertion.
Chronic chest pain caused by pressure on muscles and cartilage.

Types of Pectus Carinatum

1. Classic (Chondrogladiolar Type)

Most common type (about 90% of cases).
Features:
Protrusion in the middle of the chest (sternum).
Upper and lower halves of the chest are relatively symmetrical.
Usually symmetrical, noticeable when standing or inhaling.

2. Chondromanubrial Type

Less common than the classic type.
Features:
Protrusion at the upper chest near the manubrium.
May be asymmetrical.
Sometimes associated with mild breathing difficulties or chest pain.

3. Mixed Type

Combination of classic and chondromanubrial types.
Protrusion appears in both the upper and middle chest.
More complex to treat, especially with significant asymmetry.

4. Asymmetric Type

One side of the chest protrudes more than the other.
Can be difficult to classify precisely due to individual growth differences.
Requires careful evaluation through imaging and clinical examination to plan treatment.

Diagnosis of Pectus Carinatum

1. Clinical Examination

First step in diagnosis.
The doctor observes:
- Chest protrusion and symmetry.
- Changes in chest shape during inhalation and exhalation.
- Skin and cartilage condition to check for additional problems.
In most mild and moderate cases, clinical examination is sufficient for diagnosis.

2. Medical and Family History

Ask when the deformity first appeared.
Inquire about similar cases in the family, as Pectus Carinatum often has a genetic component.
Evaluate physical symptoms such as breathing difficulty or chest pain.

3. Imaging Studies

Used to assess chest shape and deformity severity:

a. X-ray:

General view of the sternum and ribs.
Helps determine protrusion degree and chest shape changes.

b. CT Scan:

Used in moderate to severe cases.
Provides detailed images of bones, cartilage, heart, and lungs.
Helps assess any pressure on the heart or lungs.

c. MRI:

Less commonly used.
Useful for evaluating soft tissue around the chest if needed.

4. Pulmonary Function Tests

Used if the child experiences breathing difficulties or fatigue during exercise.
Helps determine the impact of the deformity on lung function.

5. Cardiac Evaluation

In moderate or severe cases, the child may need:
- Electrocardiogram (ECG)
- Echocardiogram (Echo)
Especially if there is palpitations or shortness of breath during activity.

6. Assessing Severity

Based on physical appearance and imaging results.
Determines whether orthotic bracing is sufficient or if corrective surgery is required.

Types of Pectus Carinatum Surgery

1. Traditional Ravitch Surgery

Description: Classic surgery, most common before modern minimally invasive techniques.

Procedure:

Long incision in the middle of the chest.
Removal or reshaping of protruding cartilage.
Repositioning the sternum to a normal position, sometimes stabilized temporarily with metal bars.

Advantages:

Permanent correction.
Suitable for severe or asymmetric cases.

Disadvantages:

Large incision.
Longer recovery period.
More pain and noticeable scarring.

2. Modern Corrective Surgery (Minimally Invasive / Modified Techniques)

Description: Limited intervention with a small incision, less pain, and faster recovery.

Procedure:

Reshape protruding cartilage or stabilize the sternum using small removable metal bars.

Advantages:

Small scars.
Less pain.
Faster recovery.

Disadvantages:

May not be suitable for very complex or highly asymmetric cases.

3. Surgery Using a Metal Bar or Plate (Bar/Plate Technique)

Description: Uses a metal bar or plate to stabilize the chest in the correct position.

Procedure:

Inserted behind or in front of the sternum to maintain chest position.
Usually left for 6–12 months before removal.

Advantages:

Continuous correction until the bones and cartilage stabilize.
Reduces the need for cartilage removal.

Disadvantages:

Requires a second procedure to remove the bar.
Temporary post-operative pain.

4. Customized Surgery for Asymmetric Cases

Description: For cases where one side of the chest is more prominent than the other.

Procedure:

Selective cartilage modification on each side, sometimes with a small metal bar for stabilization.

Advantages:

Better results for complex cases.

Disadvantages:

Requires more surgical expertise.
Recovery period similar to traditional surgery.

Treatment with Bracing (Orthotic Devices)

1. Dynamic Compression Braces

Description: Adjustable plastic brace or belt that applies gradual pressure on the protruding chest with a front panel.

How it works:

Continuous pressure helps the cartilage grow properly and gradually reduces the protrusion.

Duration: 8–23 hours daily depending on severity and doctor’s instructions.

Advantages:

Most common and effective for mild to moderate cases.
Adjustable according to chest response.

Side effects:

Skin redness, pressure sensation, or initial discomfort.

2. Rigid Braces

Description: Strong metal or plastic device that keeps the chest in the correct position.

How it works:

Chest is held in a straight position for a long period to reduce protrusion.

Usage: Less common, mainly for cases not responding to dynamic braces.

Advantages:

Strong, constant pressure.
Suitable for resistant or severe cases.

Side effects:

Less comfortable than dynamic braces.
Higher risk of skin irritation.

3. Custom-Made Braces

Description: Tailored to the patient’s chest shape, can be dynamic or rigid.

How it works:

Fits the chest perfectly and applies customized pressure to the protrusion.

Advantages:

Best for asymmetric or complex cases.
Faster results due to customization.

Side effects:

Similar to other braces but generally more comfortable.

4. Modern Self-Adjustable Braces

Description: Advanced braces with hinges or screws to adjust pressure at home according to the doctor’s instructions.

How it works:

Start with light pressure, gradually increasing to achieve optimal results.

Advantages:

No frequent doctor visits needed for small adjustments.
More comfort and control for the patient.

Side effects: Minimal if instructions are followed.

General Notes on Bracing:

Choice depends on: severity, age and growth stage, chest symmetry.
Most cases start with dynamic or adjustable braces.
Regular follow-up is necessary to adjust pressure and avoid complications.

Pectus Carinatum Exercises

1. Chest Muscle Strengthening

Push-Ups: Strengthen chest and shoulder muscles. Start on knees, progress to full push-ups.
Chest Press / Dumbbell Flys: Tone front and side chest muscles.
Stability Ball Push-Ups: Balance chest and shoulder strength while improving core stability.

2. Back & Shoulder Strengthening

Rows (Dumbbells/Resistance): Strengthen upper back and pull shoulders back.
Reverse Flys: Correct shoulder curvature and balance the chest.
Wall Angels: Strengthen upper back and correct posture.
Plank: Strengthens core and back muscles to support the chest.

3. Posture Correction

Chest and shoulder retraction exercises: Stand straight, pull shoulders back to reduce chest protrusion.
Cat-Cow (Yoga): Improves spinal flexibility and reduces chest pressure.
Chest Stretch on Wall: Opens chest and strengthens rear shoulder muscles.

4. Deep Breathing Exercises

Deep inhale/exhale exercises to expand lungs and strengthen chest muscles.
Balloon or resistance tube breathing: Improves chest flexibility.
Arm raise breathing: Expands the chest during inhalation.

5. Additional Supportive Exercises

Core Exercises: Dead Bug, Leg Raises to support posture.
Moderate Cardio: Walking or swimming to improve lung function and overall fitness.

Notes:

Exercises complement bracing and are insufficient alone for severe cases.
Frequency: 3–5 times/week, 20–30 minutes per session.
Supervision by a physical therapist is recommended.
Results appear gradually with consistent bracing and exercise.

Home Care After Pectus Carinatum Surgery

1. Pain Management

Take prescribed pain medications on schedule.
Use cold or warm compresses as advised to reduce pain or swelling.

2. Wound Care

Keep incision clean, change dressings as instructed.
Monitor for redness, swelling, discharge, or unusual odor; report to the doctor immediately.
Avoid washing the incision with water unless permitted.

3. Activity & Movement

Avoid heavy lifting or strenuous exercise for 6–12 weeks.
Light walking improves circulation and prevents blood clots.
Gradually start deep breathing exercises to increase chest flexibility.

4. Post-Surgical Support Devices

Some cases require a metal bar or support device.
Follow doctor’s instructions for proper chest stabilization.

5. Medical Follow-Up

Regular check-ups to monitor:
- Wound healing
- Sternum and cartilage positioning
- Potential complications like infection or bar displacement
Imaging or tests may be performed to evaluate results.

6. Nutrition

Balanced meals to aid wound healing.
Increase fluids to prevent constipation, especially with pain medication use.
Focus on protein-rich foods and vitamins to support tissue repair.

7. Psychological Support

Encourage patience; full recovery may take weeks to months.
Family support reduces anxiety and motivates adherence to care instructions.

8. Important Notes

Avoid smoking and excessive caffeine during recovery.
Refrain from activities that apply direct pressure on the chest until fully healed.
Regular medical visits and monitoring prevent physical and psychological complications.