bubble_chart Overview

Pigeon breast deformity is generally considered to be related to genetics, similar to fistula disease pectus carinatum. Most people believe it is caused by excessive growth of the ribs and costal cartilage, with the sternal deformity being secondary to the rib deformity. Chest wall deformities that affect respiratory and circulatory functions, such as fistula disease pectus carinatum, pigeon breast, and pectoral muscle fissures, not only impose psychological burdens and personality impacts due to the deformity but also require surgical correction for the damage they cause to respiratory and circulatory functions.

bubble_chart Etiology

Pigeon breast deformity is generally considered to be related to genetics, similar to fistula disease and pectus carinatum. Most believe it is caused by excessive growth of the ribs and costal cartilage, with sternal deformity being secondary to rib deformity. Some attribute it to abnormal development of the diaphragmatic attachment, where the anterior part of the diaphragm is underdeveloped and does not attach to the xiphoid process and costal arch but instead attaches to the posterior rectus sheath. During deep exhalation, the costal arch is pulled inward, while during deep inhalation, the upper rectus abdominis muscle contracts inward, deepening Harrison's groove. The lower sternum, lacking diaphragmatic support, moves forward, resulting in pigeon breast deformity. Others suggest that pigeon breast deformity is associated with recurrent chronic respiratory infections. Long-term chronic respiratory infections reduce lung tissue compliance and weaken respiratory function. To meet respiratory demands, increased diaphragmatic movement pulls Harrison's groove inward, gradually forming pigeon breast deformity.

bubble_chart Clinical Manifestations

Most pigeon breasts are not noticeable at birth like fistula disease pigeon chest, but are often gradually noticed after the age of five or six. Generally, pigeon breast rarely causes symptoms of compressing the heart or lungs. Severe cases of pigeon breast often present with recurrent upper respiratory infections and bronchial asthma, reduced exercise tolerance, and easy fatigue. More importantly, patients bear significant psychological burdens due to the deformity.

Pigeon breast and fistula disease pigeon chest are antagonistic, with the sternum protruding forward. There are generally two types: the first is the common type, featuring a fossil bone-like protrusion of the thorax, where the lower part of the sternum protrudes more noticeably than the upper part. Often, the xiphoid process attachment is the most prominent, and the longitudinal section of the pectoral muscles appears arched. The 4th to 8th costal cartilages on both sides form deep, parallel grooves along the sternum, making the protrusion even more pronounced—as if a giant hand had grabbed the sternum and pressed the costal cartilages on both sides inward. The other type of pigeon breast is less common, where the manubrium, upper part of the sternal body, and upper thoracic costal cartilages protrude forward and upward, while the middle part of the sternal body curves backward, and the lower part of the pectoral muscles protrudes forward again. The sagittal section of the sternum forms a "Z" shape, and the costal cartilages on both sides also curve inward. For this reason, some classify this deformity as fistula disease pigeon chest.

bubble_chart Diagnosis

Pigeon breast has a lower incidence than fistula disease, with milder clinical symptoms, so it often does not receive much attention from patients and their families. Mild cases of pigeon breast often do not require medical consultation, while more severe cases show obvious deformities and are easily diagnosed clinically. Lateral chest X-rays can clearly reveal the sternal deformity, while other examination methods usually show no abnormalities.

bubble_chart Treatment Measures

The treatment of pigeon breast also requires surgical methods.

1. Superior and inferior vascular pedicle sternal turnover: The surgical method is the same as that for fistula disease pectus carinatum.
2. Non-pedicle sternal turnover: The method is also basically the same as the surgical approach for fistula disease pectus carinatum, except that the ribs and costal cartilages in pigeon breast are longer. The 3rd and 4th ribs and costal cartilages in pigeon breast are the longest, while the 5th rib is relatively shorter, requiring special attention during surgery.
3. Sternal and costal depression procedure: A midline or transverse incision is made on the anterior chest, the pectoralis major muscles on both sides are separated to expose the deformed sternum and bilateral costal cartilages. The rectus abdominis is detached at its attachment point and flipped downward. The periosteum of the ribs is incised, and the excessively long portions of the affected costal cartilages within the deformed area are excised. The overly long periosteum is longitudinally sutured and shortened. If the sternal deformity is severe, a transverse wedge osteotomy may also be performed to flatten the sternum, which is then fixed with steel wires. The pectoralis major muscles are approximated and sutured, and the rectus abdominis is sutured to the front of the sternum. The surgical outcomes are highly satisfactory.

When surgically correcting pigeon breast deformity, attention must be paid to whether the originally protruding sternum might compress the heart postoperatively. Therefore, preoperative careful examination of chest X-rays and CT scans is essential. If there is no lung tissue between the sternum and the heart, postoperative sternal compression of the heart may occur, and the sternum should be appropriately elevated during surgery.