Division of Pediatric General, Thoracic and Fetal Surgery

A Guide to Your Child's Surgery

Our Surgery Guide will help you and your family prepare for your child's upcoming surgery, outlining what to expect from the first pre-op visit all the way through to her discharge.

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Pectus Carinatum

Pectus carinatum is a condition that causes the chest to a have a “bowed out” or “pigeon chest” appearance. The condition, which affects one out of every 500 children, is caused by an overgrowth of the costal cartilages which connect the ribs to the sternum. Pectus carinatum affects more boys than girls and usually begins during early puberty (10-13 years old).

Although some children have pain and tenderness in the “bowed out” area, most children with pectus carinatum do not have any symptoms. Pectus carinatum does not usually have an effect on the function of the heart or lungs, except in severe cases.

There is no known cause for pectus carinatum. It can sometimes run in families — which suggests genetics may play a role.

Pectus carinatum can also be associated with connective tissue disorders such as Marfan syndrome and Ehlos-Danlos syndrome. About 20 percent of children with pectus carinatum also have scoliosis.

Evaluation & Treatment

Pectus carinatum is diagnosed by a thorough health history and physical exam.

Treatment is dependent upon the severity of the defect and the child’s symptoms. In most cases, surgery is not indicated.

At CHOP, we offer two treatments for pectus carinatum. After a thorough examination, we may recommend:

External Brace Therapy

External bracing may be recommended for children up to 16 years of age who have mild to moderate pectus carinatum. The concept of the brace is to re-shape your child’s chest similar to how braces re-align your child’s teeth.

The custom fitted brace has 2 cushioned plates. One rests on the most “bowed out” part of the chest and the other is in the middle of the back. The plates are connected to an aluminum bar with adjustable ratchets. The front of the brace puts pressure on the chest wall while the back of the brace keeps it stable. The constant pressure slowly molds the chest wall into the correct position.

The brace is designed to be worn either on top of or under a t-shirt, depending upon what is most comfortable for your child. The brace should be worn at least 12 hours during every 24-hour period. It does not need to be worn continuously, but must be worn regularly day or night for two years or until growth is complete.

Your child will need to be highly motivated to wear the brace, and the more it is worn, usually the better the results.

Frequently asked questions: External brace therapy

Where will my child get the brace fitted and adjusted?

CHOP has a National Orthotics and Prosthetics Company (NOPCO) Brace Shop on campus. The specialists (orthotists) in the shop will custom fit the brace for your child, which can be adjusted as needed.

Your child will need to return to the brace shop and the surgery clinic 4 to 6 weeks after the initial brace fitting. After that, your child should have the brace adjusted as necessary. Your child will continue to be monitored at our clinic every 4-6 months while he or she is using the brace.

Is the brace uncomfortable?

It takes some time to get used to the brace, but your child should not be uncomfortable. Your child will begin using the brace for short periods of time at first. He will wear it a little bit longer each day. If your child complains about the brace hurting, make an appointment with the brace shop or the surgery clinic to have it checked.

How should I take care of my child’s skin while using the brace?

You and your child will need to make sure there is enough pressure on the chest. There should be a red mark over the chest where the cushioned plate is. This mark should be visible for several hours after your child removes the brace.

You should not see skin breakdown such as open skin ulcers or blisters. If you see skin breakdown, remove the brace and call the specialist that fitted the brace. Don’t use lotion on skin where the pads rest because this could soften the skin and cause skin breakdown.

How do I clean the brace?

You can clean the pectus carinatum brace with rubbing alcohol or mild soap and water. Heat will ruin the brace. Do not put it in the dryer or use a blow-dryer on it.

How effective is this treatment?

We have treated more than 100 children with pectus carinatum in this type of brace since 2006 and have found the brace to be very effective when used correctly. To get the best results, your child needs to wear the brace exactly as the doctor orders.

Will this be covered by my insurance?

NOPCO will check with your insurance company to see if the brace is covered. If your insurance does not pay for care at NOPCO, we have access to other vendors that make the device. We can provide medical documentation to your insurance company if needed.

Ravitch Procedure

At CHOP, the Ravitch procedure is used to correct severe pectus carinatum or in cases in which brace therapy is contraindicated. This procedure involves an incision across the chest and the removal of the cartilage that causes the defect. The sternum is then placed in the normal position.

The extent of the operation depends upon the severity of your child’s pectus carinatum. The cartilage will regenerate over the next 4-6 weeks, causing the sternum to be in a fixed position. A small drain is at the site of the operation to prevent a fluid collection.

Follow-up care after the Ravitch procedure

Following the Ravitch procedure, your child will remain hospitalized for 3-5 days. The length of hospitalization is mainly determined by pain management.

Initially, IV pain medications will be used to control your child’s pain. When your child begins to eat, oral pain medications will be used.

In the hospital, your child will have activity restrictions that will continue after discharge. The restrictions are in place to protect your child’s chest during cartilage regeneration. Your child’s surgeon or nurse practitioner will discuss these restrictions with you.

After being discharged from the hospital, your child will follow-up in the general surgery clinic in 2-4 weeks.

Resource for families

The Children’s Hospital of Philadelphia created a printable resource to help you better understand pectus carinatum and the bracing typically used to treat the condition.

See Caring for Your Child: The Pectus Carinatum Brace for details.

Contact us

To make an appointment to have your child evaluated by CHOP’s Division of Pediatric General, Thoracic and Fetal Surgery, please call 215-590-2730.

For questions regarding the fit and comfort of your child’s brace, contact the Brace Shop at the National Orthotics and Prosthetics Company (NOPCO) at 215-590-7702.

Created by: Mary Kate Klarich, MSN, CRNP, & Natalie Walker, MSN, CRNP
Reviewed by: N. Scott Adzick, MD, MMM, FACS, FAAP
Updated March 2012

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