What is Pigeon Breast (Pectus Carinatum)?
Pigeon breast is a breast wall deformity that results in the middle of the breast protruding due to overgrowth of cartilage between the ribs and the rib cage bone, also known as the rib cage.
Pectus carinatum, or pigeon breast, is named this way because it visually resembles the breast of birds.
Pigeon breast, a condition that is more common in men than women, is seen in 6 out of 1000 children.
Although the underlying cause of this disease, which becomes evident at the age of 11 and later, especially during adolescence, is unknown, genetic predisposition may be an important factor in the development of this condition.
What are The Causes of Pigeon Breast (Pectus Carinatum)?
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Genetic Factors:
Pectus excavatum is thought to have a genetic component because it often runs in families. However, the exact genes involved have not been fully identified.
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Abnormal Development of the Breast Wall:
Abnormal development of the ribs and sternum during fetal growth is believed to play a role in the formation of pectus excavatum. The specific factors that contribute to this abnormal development are still not well understood.
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Connective Tissue Disorders:
Some cases of pectus excavatum have been associated with underlying connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, which can affect the structure and development of the breast wall.
What are The Symptoms of Pigeon Breast (Pectus Carinatum)?
The symptoms of pigeon breast may vary from person to person and depending on the level of the disease.
These:
- Tiredness
- Difficulty breathing
- Breast pain
- Fast heartbeat
- Frequent respiratory infections
How to Diagnose Pigeon Breast (Pectus Carinatum)?
The most important and sometimes only symptom of pigeon breast is the deformity caused by the breastbone being pushed outwards. A breast x-ray is requested to examine the person’s breast bones.
In more serious and advanced cases;
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
It is checked whether surgery is required or not.
Pigeon breast can be diagnosed as a result of physical examination and imaging studies.
What are the Treatment Methods for Pigeon Breast (Pectus Carinatum)?
There are different surgical and non-surgical treatment methods used in the treatment of pigeon breast. Which of these to use is decided by looking at the severity of the disease and the patient’s wishes.
The main treatment methods used in pigeon breast disease are as follows:
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Modified Ravitch Surgery:
For this procedure, an incision is made in the mid-breast area. Abnormal cartilage is removed and the rib cage is pushed downward.
In addition, when necessary, a temporary metal bar is placed on the breast to keep the rib cage in the desired plane.
The duration of hospital stay after this surgery, which is a painful procedure; It varies depending on the patient’s condition and pain control.
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Abramson Surgery:
Abramson surgery is a minimally invasive procedure performed through small incisions. It takes approximately 30-45 minutes and general anesthesia is applied.
During the surgery, small incisions are made on both sides of the breast, as in the Nuss surgery.
Through these incisions, the Lorenz bar, which was previously prepared specifically for the patient, is placed between the bead board and the muscle tissue and pressed down. The surgery ends by fixing the bar to the ribs on both sides of the breast wall.
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Orthosis Treatment:
Orthosis treatment, commonly known as corset treatment, aims to correct the sternum over time by applying pressure from the front and back to the protruding part of the sternum. Although it varies from person to person, it is recommended to wear the corset for at least 8 hours a day for six months to improve the shape of the breastbone.
When to Remove the Lorenz Bar?
Lorenz bar placed surgically;
- After 2-3 years for those under 18 years of age,
- After 3-4 years for those over 18 years of age,
It is removed in a 30-45 minute procedure under general anesthesia.
Home Care After Pigeon Breast (Pectus Carinatum) Surgery
- Individuals who have a breast support placed during the Ravitch procedure will be called for follow-up appointments at least once a year after the first post-operative visit. The breast support may need to remain in place for 2-3 years.
- You can take a shower 5 days after the surgery.
- There are no stitches to be removed, the stitches are under the skin and can dissolve on their own.
- Narcotic pain treatment may be required for up to one month after surgery.
- Constipation is a common problem and daily use of laxatives is recommended when using narcotics.
- Redness or swelling at the incision(s) should be reported to the doctor as soon as it is noted.
- If the person is discharged with a drain, the drain will be removed in the hospital when the drainage stops. The person can resume sports as soon as the surgeon decides it is safe.
