Alex's chest shape before and after treatment with the vacuum bell and rib flaring brace
24 January 2025
When he was 13 years of age, Alex had just showered and looked in the mirror and was worried by the appearance of his chest. It was indented and his ribs were sticking out. His family sprang into action and searched online to see if they could find out what the problem was.
They concluded that Alex had something called pectus excavatum (PE), sometimes referred to as ‘sunken’ or ‘funnel’ chest; he also had flared ribs. Pectus excavatum happens when the chest bone is pushed inwards by an overgrowth of cartilage between the ribs and the breastbone.
The condition tends to become exaggerated during puberty where growth spurts cause the cartilage and bones to grow rapidly. The sternum becomes caved in, looking “dented” or “sunken.” The ribs often tend to flare out due to the excavatum area sinking inwards. The cause of pectus excavatum is unknown, though there's thought to be a hereditary aspect as patients with pectus usually have family members who have had the same condition. In Alex’s case, his grandfather had it.
While searching for potential treatments for Alex, his parents found that the NHS seemed only to be offering a surgical solution to PE, which was not something the family wanted to consider. But in their online searches, they found the London Orthotic Consultancy and discovered our clinic in Bristol, close to where they lived.
Initially, they arranged a free virtual consultation with Sam Walmsley, director of LOC, who had introduced the concept of non-surgical treatment for pectus conditions to the UK in 2010. Satisfied that the treatment was suitable, they booked a face-to-face consultation for May 2022.
Chest shape during his initial assessment showing his indented sternum
Sam Walmsley talks through the features of our slimline pectus brace
Alex’s father, Lee, remembers a key moment in that consultation: “Sam asked Alex to hold his breath and see if he could push his chest out, it’s called the Valsalva manoeuvre, and it’s a way of increasing pressure on the chest. This was a game changer for us as it demonstrated that Alex’s chest shape could be improved. We were then able to see what his chest would look like after treatment, which was quite extraordinary. Alex had a clear idea of the end goal.”
Our treatment protocols for Alex included a mini vacuum bell (to treat the PE) and a bespoke brace to push his flared ribs back in, plus individual exercises and participation in online classes with Alva Yoga. Both the vacuum bell and the rib flaring brace (or dynamic chest compressor) have strict wearing protocols, the brace at the start of treatment should be worn most of the day and night.
Alex's chest shape before and after vacuum bell therapy
At school, Alex did not tell his friends that he was wearing a brace. It was winter so it was possible to hide it under layers of clothing and just take it off for sports. Alex’s adherence to both the required wear times and exercise programme were an important part of the success of his treatment, Alex even set up his own gym in their garage so he could do his exercises in peace.
After two years, the end result a completely flat chest, 100% correction. Alex comments: “To be frank it was not easy at the beginning, but you just have to put the time and effort in, and the end result speaks for itself. Sam was great, always supportive, and would sort out any issues I had with my brace quickly. I am so pleased with how my chest looks now.”
Lee adds:” The treatment is really pretty straightforward considering what had to be achieved. I would totally recommend it to parents whose children have the same condition.”
If you or your child is concerned about their chest shape, book a free online pectus appointment with one of our clinicians today.
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.
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.
