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Pectus Excavatum

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Pectus Excavatum

BY Jon W

01 June 2016 According to a study carried out in 2012 by the Centre for Appearance Research, 70% of adult women and 40% of adult men say they have felt pressure from television and magazines to have a perfect body. This is why films like Ellie Jane’s are so important. Ellie has a condition known as pectus excavatum and when we came across her YouTube video we knew straight away that we wanted to share it with you. There are two main types of pectus anomaly – excavatum and carinatum – and both occur between the ribs and the sternum (or breast bone). As the cartilage between the ribs grows longer, the sternum is pushed either inwards (pectus excavatum) or outwards (pectus carinatum). The condition occurs before a child is born and there is evidence to suggest that these are hereditary conditions. Pectus excavatum, which Ellie has, is also known as 'funnel' or 'sunken' chest and often becomes more obvious during early adolescence when growth is rapid. Although many people with pectus don’t experience severe physical symptoms, it can have a significant impact on self-confidence. Like Ellie, we often hear patients say that they are unwilling to be seen without a shirt while swimming or during other social activities.

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      At LOC, we see more young men than women with pectus, but there is no data on the true gender split and, just because we don’t see as many young women, it doesn’t mean they’re not out there. Which is another reason why Ellie’s film is so inspirational.  In severe cases of pectus, surgery may be recommended. Good results have been reported, but it is a major procedure with risks attached and often does not address the problem of the flaring of the ribs, which is fairly common. Patients can also be left with visible surgical scarring. LOC does not carry out the surgery. Instead, we follow the methods of Dr Haje, who – before passing away in 2012 – successfully treated more than 1,900 patients from all over the world at his clinic in Brazil. Dr Haje showed that it was possible to improve chest wall shape with a combination of bracing and exercise. Our LOCpectus non-surgical treatment of pectus involves wearing a bespoke brace, known as a Dynamic Chest Compressor, in conjunction with a device called the Vacuum Bell plus daily exercises. The optimum age for non-surgical treatment is during puberty, as the chest wall is still pliable, but the process does require a lot of work from the patient. But we have seen good results that make that effort worthwhile. If you would prefer to investigate surgical treatment, we have developed strong links with consultants across the UK and would be happy to recommend someone for you. In the meantime, we want to congratulate Ellie for taking such a bold step to help more people understand this condition.  If you would like to find out more about costs, then contact LOC. We offer a free initial consultation so that a prospective patient can be examined and the treatment options discussed without any commitment to proceed.

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FAQs:

What's the best age to start chest bracing treatment?

This depends on several factors; the position of the chest wall deformity, its severity, the flexibility of the chest, the kind of results wanting to be achieved and the age of the person undergoing treatment for pectus excavatum or pectus carinatum. Early adolescence (roughly between the ages of 12-16 years old) – is an optimum age to start treatment, given that the chest is still maturing, and flexible, permanent correction is more easily achievable. Once bracing treatment is complete and a patient has stopped growing, the deformity will not return. For younger pectus patients, conservative bracing is used to keep a deformity from worsening and can help them to avoid surgery in later life. For older pectus patients (between the ages of 20 to 30) results can be harder to achieve, as the costal cartilage hardens into the bone as a person matures. Over the years we have successfully treated many adults for both pectus excavatum and pectus carinatum and active adults with flexible chests can expect good results.  

What outcomes can pectus patients expect from bracing treatments?

Again, this hugely depends on what a patient wants to achieve from treatment; whether that’s avoidance of surgery, improvement in the appearance of the chest shape, reduction in rib flaring etc. All these goals are taken into consideration during your first consultation. While there are no serious health risks of having pectus carinatum or excavatum – beyond the cosmetic – for many patients and parents, treatment outcomes involve improving confidence and self-esteem.  During our 2018 Pectus Patient Survey, 92% of pectus carinatum patients surveyed said that treatment had a ‘major improvement’ or ‘an improvement’ on their social life. You can read the results of our 2018 Pectus Patient Survey and quality of life questionnaire here.  

How often do I need to come in for check-up appointments?

Regular reviews are part of the treatment programme, preferably in clinic with one of our specialist orthotists, or via Skype consultations. The number of appointments needed will vary from patient to patient but as a general rule, younger pectus patients who are growing at a faster rate will need to be seen more regularly for check-up appointments. This is to ensure that the brace fits well and is guiding the chest into the correct position as growth spurts occur. For other patients, this can be scaled back according to their individual needs and demands. Regular appointments are beneficial for assessing progress, checking for signs of rubbing and determining whether another brace is needed. Appointments are also good for checking patient compliance to brace wearing and the breathing and exercise programme. At each appointment, we make time for patients to see our physiotherapist to fine-tune their exercise programme and check to see how a patient has been managing with the current programme. We always advise coming in for appointments whenever you have any concerns about the brace or treatment programme, especially if a brace is rubbing or not fitting correctly. At the London Orthotic Consultancy, we have treated numerous international patients that have benefitted from specially designed braces that leave room to accommodate for growth and that can be adjusted remotely. Follow-up appointments for international patients are conducted via Skype.  

How visible is the chest brace under clothing?

This is a very common concern for patients considering treatment; in general, the dynamic chest compressor brace is easy to conceal if you are wearing a loose-fitting shirt for school or work. If you are wearing two chest braces – one for the main deformity and the other for rib flaring – then this may be more noticeable, especially under a t-shirt. Normally loose-fitting clothing will conceal the brace, though it’s likely it will be seen through tight-fitting clothes.  

Can I exercise when going through chest bracing treatment?

It is really important to continue exercising while going through bracing treatment. Exercise is fundamental to keeping the chest wall flexible. Our treatment programme incorporates a daily exercise routine of around 30-40 minutes of stretching using yoga poses, resistance bands, deep breathing exercises and general muscle stretches. Deep breathing exercises allow the lungs to expand against the chest wall, pushing it outwards. Exercising with the brace on in the later stages of treatment can also make the chest correction more stable and permanent. Swimming is one of the best forms of exercise to complement bracing treatment, as the body positions required to swim imitate the resistance band training designed to stretch the chest and increase its flexibility. Some swimming strokes are better for this than others, please check with your clinician. The brace should always be removed for contact sports and for swimming.  

Will I need more than one chest brace throughout treatment?

For most patients, one brace is often all that is needed to achieve a desired level of correction. They are each designed to last the duration of treatment and accommodate any growth that may occur in that time. Some patients have benefitted from having two braces – one to treat the main deformity and the other to treat rib flaring. For some pectus excavatum patients, having a brace apply pressure to the ribs – in addition to vacuum bell therapy – can greatly reduce the appearance of the depressed sternum area of the chest, forcing it upwards and outwards into a more corrective position.  

What advice would you give to people considering treatment?

If you are worried about your chest shape, or your child’s chest shape, then get in touch for a free Skype consultation with one of our pectus specialists who can assess their chest and discuss treatment options. We are always happy to communicate with local GPs, thoracic surgeons and consultants if a patient approaches us for bracing treatment after considering other options.  

Related Pages:

Pectus Overview Pectus Excavatum Pectus Carinatum Pectus Treatment