11 March 2022
Michael started noticing his pectus excavatum when he was 8 years old, treatment is not recommended at this age so his parents waited to see if it would correct naturally. It was actually during lockdown when Hilary (Michael’s mum) started to research possible treatment options, by this time Michael was 12 years of age. She initially found out about the Nuss Procedure, which is an established surgical technique but it is invasive, so Hilary kept looking for a non-surgical option and she found LOC.
Hilary booked an initial free virtual consultation with Sam, LOC’s director who had himself introduced the concept of bracing treatment to the UK in 2010. Hilary says: “Sam suggested we go see one of LOC’s clinicians in Bolton, John Turner. We had a first consultation with John that was brilliant and put Magnus at ease.” John’s clinical notes describe Michael’s presentation as central excavatum with mild rib flaring.
The excavatum could be treated with the vacuum bell. The rib flaring was also discussed. Hilary explains: “While Magnus was quite keen on doing the treatment, he didn’t like the idea of using a brace for the rib flare. John agreed that the rib flaring was not severe, and it could improve with physio exercises.’’
The vacuum bell works by creating a vacuum over the depressed sternum area to lift the sunken part of the chest out. It is widely used in German, Austrian and Swiss clinics.
Right after the fitting of the vacuum bell, the whole country was put into another lockdown. Treatment was not interrupted however as Michael was seen regularly for virtual review by John and LOC’s physio. Hilary reported the importance of these virtual sessions for Michael – he started doing physio exercises that were incredibly beneficial for his posture and for building up the muscles on his chest. The number of hours and commitment was significant, but Michael was determined to get his chest into a more normal shape.
Hilary says: “Michael is now 14 years old and has started attending the yoga classes with Alva (an integral part of LOC’s pectus treatment programme), and sometimes I join the classes to make sure that he follows the yoga exercises till the end of the lesson. When he started, he couldn’t even do one press up and now he does plank and side plank easily under Alva’s instructions. We have noticed that his posture has improved a lot and his back is much straighter. Overall, we had a great support from John and the whole team. Although the pectus is still visible and it won’t go away completely, there has been some significant noticeable physical improvements and Michael feels more self-confident. Michael told his friends about his treatment and because some of them need help with other daily struggles like dyslexia, he received great support from them all. His generation are much more open and are prepared to support and help those who may have issues.”
Obviously parental input and support is also very important: “Michael had days of demotivation, so as a parent you need to be extra supportive and push them to keep going because the results are certainly worth the efforts. Michael has developed abdominal muscles and his posture is markedly improved. The whole treatment programme has meant he has started having an interest in his physical appearance, going to the gym has become a healthy habit that I hope he will never drop.”
Above: LOC's Dynamic Chest Compressor
For patients considering LOC’s non-surgical treatments for pectus carinatum, the initial virtual consultation is free with no obligation to proceed. During the consultation, one of LOC's clinicians will examine your chest and general posture.
If the clinician believes that your chest shape will respond using the dynamic remodelling method and that you are willing to commit to the exercise programme, they will take 3D scans of your chest shape. Further appointments will be made for casting and fitting and you will need to attend the clinic for regular reviews.
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.
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.
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.
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.
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.
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.
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.
