What is Pectus Excavatum?
Pectus excavatum is the most common form of congenital chest deformity, also referred to as ‘sunken’ of ‘funnel’ chest. Pectus excavatum occurs in an estimated 1 in 300-400 births (Medscape). It’s also 3-5 times more common in men.
It happens when the chest bone is pushed inwards by overgrowth of cartilage between the ribs and the breast bone. The condition tends to become exaggerated during puberty where growth spurts cause the cartilage and bones to grow at a rapid rate. The sternum becomes caved in, looking “dented” or “sunken”. The ribs often tend to flare out as a result of the excavatum area sinking inwards. Scoliosis is also associated with the disorder.
After puberty, the bones and cartilage in the chest stop undergoing growth spurts and therefore the chest will remain ‘stable’ when a person reaches adulthood.
For patients considering LOC’s non-surgical treatments for pectus excavatum, the initial consultation is FREE with no obligation to proceed. During the consultation one of LOC's clinicians will examine your chest and also your general posture. They will look at your alignment from head to toe if required, looking for signs of asymmetry.
The cause of pectus excavatum is unknown, though the condition is thought to happen as a result of abnormal cartilage growth, between the bony ribs and the breast plate, causing the sternum – or breastbone – to buckle inwards (when it protrudes outwards, this is referred to as Pectus Carinatum).
There is thought to be a hereditary aspect as patients with pectus usually have family members that have gone through the same. According to the American Board of Family Medicine about 40% of pectus patients have family members with pectus deformity but a genetic link is not yet fully understood.
Pectus excavatum is also associated with rare musculoskeletal syndromes like Marfan syndrome. For more information, head to our Causes page.
Those with pectus excavatum will characteristically have their breast bone – or sternum – appear ‘sunken’ into the chest, like a dent. The severity of the ‘sunken’ excavatum area can vary greatly from patient to patient, and some may also have asymmetrical cartilage growth. Ribs flaring out below the excavatum area is also a common feature.
Many who have pectus carinatum do not experience any further symptoms outside of their appearance. Some have other associated complications listed below.
Psychological Impact of Pectus Excavatum
Having pectus excavatum is made more difficult with the reduced self-esteem which often accompanies it. While some people accept the shape of their chest, for others it can be a daily source of anxiety, low self-confidence and increased self-consciousness. Some cases are more drastic than others, and adolescents may find the appearance of their chest disturbing, or worry about others seeing it.
Issues with self-esteem and body image perception may become exacerbated during teenage years. In a 30 year Californian study carried out by UCLA School of Medicine the most common complaint for young patients was related to the unattractive physical appearance of the deformity. The psychological effects are normally enough to warrant the need to seek corrective help.
Sometimes other problems associated with pectus excavatum include:
- reduced ability to exercise
- decreased stamina
- decreased endurance
- Heart palpitations
- 32% of patients have respiratory problems (UCLA)
- 24% have functional heart murmurs (UCLA)
- 16% of patients have mild or moderate scoliosis (UCLA)
Though not universal, we don’t want to overstate the potential respiratory or heart problems associated with the condition; many people with a pectus deformity do not suffer from any of the above. Many patients find the psychological distress caused by having a pectus deformity much more distressing than its stated complications.
Surgery is an option for those who do not feel like they can commit to physiotherapy exercises or wearing a brace constantly. We do not offer surgical treatment, though we are able to advise on the best solution and help patients who have undergone surgery with post-operative bracing.
We are proud to pioneer non-surgical treatment, though patients who are older, with chests that are naturally less flexible may respond better to surgery. For more information on surgical procedures, head to our Pectus Treatment page.
The London Orthotic Consultancy’s treatment programme (LOCpectus) for pectus excavatum involves wearing a bespoke brace – the Dynamic Chest Compressor – in combination with the use of a device called the 'Vacuum Bell' and a programme of daily exercises. The dynamic chest compressor 2 works on the flared ribs that are stereotypical of pectus deformity. Sometimes rib flaring can be significantly contributing to the excavatum and without correcting it, the overall result is often unsatisfactory.
The Vacuum Bell was invented by Eckart Klobe, a graduate in chemical engineering; it has been used with success by a number of German, Austrian and Swiss clinics over the past decade. The mechanism uses a suction cup to create a vacuum at the anterior chest wall, used to lift the sternum up and out. The brace is used with the vacuum bell to enhance that correction, and to also correct rib flaring.
We use a daily exercise program in conjunction with the dynamic chest compressors to achieve the best possible results. Part of our treatment plan incorporates routines involving stretching using latex resistance bands, yoga poses, deep breathing exercises and general stretching of the chest area. Deep breathing exercises allow the lungs to expand against the chest wall, pushing it outwards.
Dr Haje pioneered the non-surgical treatment of pectus excavatum and demonstrated that it was possible to improve chest wall shape using his methods. He showed that the chest wall shape could be improved with a combination of bracing and exercise treatment.
You can find out more about bracing treatment for pectus excavatum on our LOCpectus page.