Peeled chest deformity - effective treatment methods

1.What does the diagnosis of “keeled breasts” mean?

Keeled breasts (also called “chicken breasts”) are a developmental abnormality of the bones of the chest. The sternum and costal cartilages develop incorrectly during growth, which leads to the formation of a clear cosmetic defect. The middle part of the chest protrudes forward, and the ribs along the edges of the sternum are sunken. Such retraction can be symmetrical or unilateral and most often covers the fourth to eighth pairs of ribs.

“Chicken breast” has such a shape that the chest seems to be constantly in a state of inhalation - its shape does not change during the respiratory excursion.

This pathology is most typical for people of asthenic physique. Additionally, people with Marfan disease are more likely to develop keeled breasts. Also rare is the combination of a keeled chest with scoliosis, ankylosing spondylitis and congenital heart defects associated with myocardial stretching.

The hereditary nature of keeled breasts is confirmed by data according to which the presence of a relative with this disease increases the likelihood of a similar defect occurring in other family members.

The incidence of keeled breasts is related to gender—in girls this defect is four times more common than in boys. The development of this hereditary pathology is realized due to the uneven (excessive) growth of cartilage and bone tissue of the chest and ribs.

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Causes

The immediate cause of the formation of a keeled chest is a failure of intrauterine development of the fetus, and the child is born with an anomaly. Since in some cases the pathology is diagnosed jointly with pectus excavatum (another congenital anomaly), a version of the same causes of origin and mechanism of development of these two disorders is considered.

It has been established that a keeled chest is more often formed in patients with a certain constitution and the degree of development of their connective tissue. So, in most cases, such patients are characterized by:

• high growth;
• asthenic type of constitution. This means that such a person has a thin physique, and his height is generally too large, although as a result of some malfunctions in the growth zones of the bones he may be too small. The narrowness of almost all body fragments is determined - the chest, pelvis, shoulder girdle, and so on. The face is oblong, and the upper and lower limbs are disproportionately long. Characteristic signs are such as a small volume of muscles and subcutaneous fat, pallor of the skin and visible mucous membranes.

The hereditary nature of the keeled chest is indicated by the following facts:

• In the family of a patient with keeled chest deformity, similar cases of the disease have already been encountered. At the same time, both close relatives (brothers, sisters, parents) and distant relatives (grandfathers, great-grandmothers) could get sick;
• in such patients, other malformations are much more often diagnosed - both on the part of the chest and the organs that are located in it, and on the part of organs and tissues of other localizations.

It often turns out that a child with a keeled chest was born to a mother whose pregnancy did not have the right conditions and was accompanied by the influence of various pathological factors on the woman’s body (and therefore on the body of the unborn child). Such factors can be divided into groups:

• physical;
• chemical;
• psychological;
• somatic;
• endocrine;
• bad habits.

Physical factors that can negatively affect the course of pregnancy and provoke the intrauterine formation of a keeled chest in the fetus include:

• mechanical;
• thermal;
• radioactive.

Mechanical factors are banal injuries to the pregnant woman’s abdomen. They are:

• unintentional;
• intentional.

Unintentional injuries occur as a result of negligence or an accident. Abdominal injuries can be caused by negligence under the following circumstances:

• everyday inconveniences (for example, a small living space, often cluttered with household items);
• active behavior of a child who is already in the family. Thus, a pregnant woman can often get injured while calming a capricious child, who can then hit her in the stomach.

Abdominal bruises in a pregnant woman due to an accident are also a common occurrence. It can be:

• falling from a height onto your stomach;
• road traffic accidents in which a woman may hit her stomach on a hard object (for example, a steering wheel);
• falling due to tripping on a slippery road or due to a sudden obstacle underfoot

and many others.

Intentional injuries to a pregnant woman, which result in bruising of the abdomen and, accordingly, the pregnant uterus, are often injuries due to domestic violence. Facts of traumatization with a criminal connotation (assault, torture) involving a pregnant woman are less common.

The thermal factor is increased or decreased ambient temperatures.

A radioactive harmful factor is any source of radioactive exposure.

Chemical factors that provoke disruption of the normal course of pregnancy with the risk of the formation of a keeled chest in the unborn child are:

• a number of medications that a pregnant woman takes and that can disrupt the normal intrauterine development of the fetus;
• contact with aggressive compounds - industrial, agricultural, household. Most often, they enter the mother's body through inhalation of vapors or volatile substances, enter the systemic circulation, and then into the bloodstream of the fetus.

Psychological factors play an important role in the occurrence of any congenital diseases. Meaning:

• constant stress;
• psychological stress associated with an increased sense of responsibility (often observed in connection with professional activities);
• unhealthy “sluggish” psychological situation in the family - in this case, no pronounced stressful situations arise, but the interests of the pregnant woman are infringed;
• dissatisfaction with everyday and social conditions, environment, environment, cultural level.

Such factors are involved in the failure of intrauterine development of the fetus, but quite often they are undeservedly not given importance.

Somatic diseases of the expectant mother (often occurring even before pregnancy) can provoke disruption of the intrauterine development of organs and tissues - in particular, leading to the formation of a keeled chest. Often this is:

• chronic protracted bronchitis is an inflammatory lesion of the bronchial mucosa. Significant is the obstructive process, which leads to a chronic lack of oxygen;
• coronary heart disease (CHD) – disruption of blood flow through the coronary vessels supplying the myocardium, which can lead to disruption of cardiovascular activity;
• peptic ulcer of the stomach and duodenum. They lead to digestive disorders, which negatively affects the flow of nutrients into the bloodstream of the expectant mother, and then into the bloodstream of the fetus.

and a number of others.

Of the endocrine disruptions on the part of the pregnant woman’s body, the most common factor contributing to the development of a keeled chest in the fetus is:

• diabetes mellitus – a failure of hydrocarbon metabolism due to a lack of the hormone insulin;
• disturbances in the production of thyroid hormones in the form of hypothyroidism (lack of synthesis) or hyperthyroidism (excessive production).

Bad habits of the expectant mother are a real scourge that increases the chances of intrauterine fetal anomalies tens and hundreds of times. This:

• smoking - even if the woman is not an experienced smoker;
• drinking alcohol – including in small doses (for example, if these are low-alcohol drinks);
• taking drugs in any form - inhaling, taking orally, and so on.

Important

Often, banal gross non-compliance with the regime of work, wakefulness, rest, sleep and nutrition on the part of the expectant mother can provoke the development of a number of intrauterine anomalies in the fetus - in this case, a keeled chest.

2. How does keeled breast shape affect health?

Keeled breasts can be diagnosed at birth, but initially it does not affect the functioning of the heart and respiratory system. The following defect-related conditions may develop with age:

• dyspnea;
• fast fatiguability;
• tachycardia during physical activity;
• decreased vital capacity of the lungs;
• drop in oxygen consumption coefficient.

If the patient is not engaged in heavy physical work, he is usually only concerned about the external manifestation of the disease, since in a calm state the listed disorders are not expressed.

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3. Diagnosis and classification of keeled breasts

Chicken breast is detected by the surgeon during a physical examination. Additionally, radiography is prescribed, the data of which allows us to judge the nature and degree of deformation. The following abnormalities are usually visible on an x-ray:

• increase in the chest space;
• teardrop-shaped heart, its rotation along its own axis and displacement;
• delimitation of the sternum segments from each other in the lateral projection./li>

If the patient complains of difficulty breathing and cardiac activity, additional studies are carried out aimed at assessing the effect of the bone defect on the functioning of the cardiovascular system and respiratory function:

• electrocardiography;
• sonography;
• diagnostics of external respiration function.

When classifying the “chicken breast” defect, they proceed from the degree of influence of this pathology on the position of the heart:

• 1st degree - the heart is not displaced;
• 2nd degree - there is a displacement of the heart by no more than 3 cm;
• 3rd degree - the position of the heart is deviated from the norm by 3 cm or more.

In addition, the specific type of abnormal breast structure is determined:

• corpocostal (the lower part of the chest is convex);
• manubriocostal (the upper part of the chest protrudes);
• costal (the defect is localized in the area of ​​the costal cartilages).

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Price for treatment in Moscow

What are the costs associated with the treatment of chest deformity:

• appointment with an orthopedist – 2,000 rubles.
• Chest x-ray – 1,800 rubles.
• CT – 5,100 rub.
• ECG – 800 rub.
• appointment with a neurologist – 2,000 rubles
• consultation with a cardiologist – 2,100 rubles.
• spirometry – 1,500 rub.
• examination by a pulmonologist – 2,200 rubles.
• consultation with a pediatric orthopedist – RUB 2,100.
• consultation with a thoracic surgeon – 2,300 rubles.
• surgical correction of the chest – 68,700 rubles.

4. Treatment of “chicken breast” chest deformity

The management tactics and appropriateness of treatment for patients with keeled breasts are determined based on objective diagnostic indicators, taking into account the patient’s subjective complaints. With the progressive dynamics of cardiovascular and respiratory disorders, thoracoplasty is indicated - an operation to correct the osteochondral skeleton of the chest.

Correction of breast shape is most effective before the age of 14-17, since later the cartilaginous framework of the ribs, sternum and spine becomes ossified.

Sometimes the patient's only complaint is the abnormal appearance of the breasts. Unfortunately, it is impossible to correct keeled breasts with any physical exercises or physiotherapy. If there is significant psychological discomfort from a cosmetic defect, “chicken breast” is also corrected surgically. The operation usually involves excision of protruding parts of the sternum and ribs, and may also be combined with the installation of an implant. After such treatment, wearing a corset or supporting orthoses is required for some time.

If preventive measures are taken from childhood, it is only possible to slow down the development of this congenital pathology. Systematic regular exercise (push-ups, bench press, exercises with dumbbells lying on your back) in some cases can completely stop the deformation. However, even these measures do not ensure the reverse development of the defect.

Prevention

There is no way to prevent the development of congenital deformity. Prevention can only be implemented to prevent acquired curvature.

Experts give all patients a single recommendation - to start treatment on time. It is important that children play sports, which will create a strong muscular frame around the spinal column.

Author of the article:

Volkov Dmitry Sergeevich |
Ph.D. surgeon, phlebologist Education: Moscow State Medical and Dental University (1996). In 2003, he received a diploma from the educational and scientific medical center for the administration of the President of the Russian Federation. Our authors