Pectus carinatum is a deformity of the chest in which the breastbone protrudes outwards. The bulging gives the chest a birdlike appearance which is why the condition is sometimes referred to as pigeon chest. It occurs when the cartilage that holds the ribs to the breastbone has a defect, and the cartilage pushes the breastbone and ribs outwards causing the chest to jut outwards. It is unknown what causes this chest deformity, but is believed to be genetic in nature.

Each case of pectus carinatum is unique as the deformity may cause mild, moderate or severe symptoms. For those who have more severe pectus carinatum, the physical deformity can cause have serious effects on a child's self-confidence. In these cases, surgery may be needed to correct the deformity. Dr Schewitz will be able to tell you whether surgical repair may or may not be needed.

What are the symptoms or signs of pectus excavatum?

While the condition is categorised by the protrusion of the breastbone forwards, pectus carinatum is often only developed during early adolescence when the growth spurt hits. It is then that the symptoms worsen and the physical deformity begins to show.

The symptoms should begin to show in the early teen years, only getting worse and worse as the child grows. Since these symptoms are caused by the protrusion of the breast bone, it may require surgery to treat. Treatment of pectus carinatum is possible at a very early age with an external brace. If surgery is required, the best time would be at the time of the adolescent growth spurt.

With Dr Ivan Schewitz's extensive experience in the treatment of children and adults with pectus carinatum, he is compassionate in explaining the conditions to his patients, taking the time to answer any of their questions and advising the best surgical treatment options for their unique case.

As a highly specialised cardiothoracic surgeon with extensive experience in pectus deformity correction, Dr Schewitz may advise external bracing, the Reverse-Nuss (otherwise known as Abraham procedure) or Ravitch procedure for correction of pectus carinatum.

These treatment methods involve:

External bracing
While surgical repair is an option for people with severe pectus carinatum, the use of a brace may help children who are diagnosed with pectus carinatum. While the bones are still growing, a brace is worn 20 hours a day to flatten the chest in just a few months. The brace is taken off for sporting activities and for showering or bathing.

View External bracing

Reverse-Nuss (Abraham) procedure
The Reverse-Nuss procedure, otherwise known as the Abraham procedure works on the same principals of the Nuss procedure, only reversed. This surgery is considered for more severe cases where external bracing is not an option due to the severity of the deformity.

The Reverse-Nuss procedure is a minimally invasive surgery in which a long, stainless-steel bar is bent to the shape of the chest and inserted on top of the breastbone. With this bar in place, the breastbone can be moved backwards correcting the protrusion over a few years. The Reverse-Nuss procedure is an option for children with severe pectus carinatum.

View Reverse Nuss procedure

Ravitch procedure
This procedure is seldom used and is preferred for adults with pectus carinatum. During the Ravitch procedure, Dr Schewitz will remove the abnormal or defective cartilage and ribs and fracture the breastbone to allow it to be moved into its correct position.

View Ravitch procedure