Understanding chest wall deformities: Q&A with a pediatric plastic surgeon

Katelyn G. Makar, MD, MS, one of our expert pediatric plastic surgeons at Riley Children’s Health, shares insights into pectus excavatum, pectus carinatum, and Poland syndrome.

What are chest wall deformities?

Dr. Makar: Chest wall deformities are conditions where the bones and muscles of the chest don't form the way they typically do. These conditions can change the shape of the chest, but they usually don’t cause problems with how the heart or lungs work. The three most common conditions we see are pectus excavatum, pectus carinatum, and Poland syndrome.

What is pectus excavatum (“Sunken Chest”)?

Dr. Makar: Pectus excavatum is when the middle of the chest, or breastbone (sternum), sinks inward. This gives the chest a caved-in appearance. It happens because the ribs and breastbone grow in an unusual way. Pectus excavatum is usually more noticeable in teenage years and can affect how the chest looks, but it rarely causes problems with breathing or the heart. If it does cause problems, like shortness of breath during sports or other activities, then you need to see a pediatric surgeon, not a plastic surgeon. If you don’t have any problems like this, and you are bothered by how it looks, our pediatric plastic surgery team can help.

Treatment: To improve the appearance, we offer custom implants designed to fill in the sunken area of the chest, making it look more even. For girls, sometimes breast implants are also used to enhance symmetry and appearance.

What is pectus carinatum (“Pigeon Chest”)?

Dr. Makar: Pectus carinatum is the opposite of pectus excavatum. In this condition, the breastbone sticks out more than usual, giving the chest a bulging appearance. This happens because of abnormal growth of the ribs and breastbone. Like pectus excavatum, pectus carinatum usually does not cause health problems but may affect confidence or self-esteem.

Treatment: For pectus carinatum, we offer procedures that help balance the chest appearance. In some cases, breast implants can be used to camouflage the more prominent chest and create a more even look.

What is Poland syndrome?

Dr. Makar: Poland syndrome is a condition where the muscles on one side of the chest don’t fully develop, making one side of the chest look smaller or flatter than the other. This condition can also affect the shoulder, arm, and hand. People with Poland syndrome may have underdeveloped or missing chest muscles, causing an uneven chest shape. Girls with Poland syndrome either don’t have a breast on the affected side, or the breast is much smaller than the normal side.

Treatment: We can use custom implants to replace the missing muscles and make the chest look more symmetrical. For females, breast implants can be used to balance the chest and create a more even appearance. Sometimes we can also use a technique called fat grafting, where we use your own fat to reconstruction your breast, but this requires more frequent trips to the operating room.

How does pediatric plastic surgery approach treatment for chest wall deformities?

Dr. Makar: Our team specializes in procedures to improve the appearance of chest wall deformities. These treatments are mainly done for cosmetic reasons, as most of these conditions don’t affect how the body functions. However, since this is something kids are born with, insurance usually covers these procedures. We’re here to help our patients feel more confident and comfortable with their appearance. If your child has pectus excavatum, pectus carinatum, or Poland syndrome, we are ready to discuss treatment options that fit your needs.