Pectus Carinatum and Excavatum Treatment

What is Pectus Carinatum and Pectus Excavatum?

Pectus Carinatum and Pectus Excavatum, also known as “Pigeon Chest” and “Funnel or Sunken Chest”, are deformities of the anterior chest wall. Pectus Carinatum is caused when the breastbone is pushed outward, while Pectus Excavatum is where the breastbone is pushed abnormally inward. There can also be mixed presentations of both conditions. Funnel chest is more common, affecting approximately 1 in 300 people while pigeon chest affects 1 in 100 people.

Treatment Options

The normal advice given to patients with Pectus deformities is that Pectus deformities are only cosmetic problems and treatment on health grounds is not required. This of course does not take into consideration the psychological effect that the condition can have and how this can shape a sufferer’s life.

Pectus Surgery

In severe cases of Pectus Carinatum and Excavatum deformities surgery may be recommended by the NHS. This is a major procedure and as a consequence there are risks attached as with any type of surgery. The type of surgery performed in the UK is either the Nuss or Ravitch procedures. The Nuss procedure being minimally invasive compared to the Ravitch. Good results have been reported from both types of surgery and patients are generally pleased with the improvement of the chest shape. However these procedures do not address the problem of the flaring of the ribs which is fairly common and patients can be left with visible surgical scarring. 

Dr Sydney Haje, MD and The Dynamic Remodelling method

While non-surgical treatment of Pectus Carinatum and Pectus Excavatum is new to the UK, treatment using a brace or orthosis is available elsewhere in the world. The London Orthotic Consultancy’s treatment follows the methods of Dr Haje, who has successfully treated over 1,900 patients from all over the world during the last 34 years in his clinic in Brazil. Dr Haje is widely regarded as the leading authority on the non-surgical treatment of Pectus deformities. He has written several peer reviewed articles for leading orthopaedic journals and lectured at many orthopaedic conferences. He has recently been presented with The Scientific Impact award by the Brazilian Medical Association.

For more information about Dr Haje and his extensive work treating Pectus deformities please visit: www.orthopectus.net

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LOC^®pectus

LOCpectus is the name we have given to the non-surgical treatment in the UK. Over the last 12 months Dr Haje has visited the UK to train LOC’s clinicians and we have now entered into a formal professional relationship with Dr Haje. This enables the clinical team to consult with Dr Haje before and during each patient’s treatment which gives  and our patients the benefits of the many years of experience he has gained after treating Pectus Carinatum and Excavatum since 1977. 

Referral and Consultation

While we welcome self-referrals, LOC would expect patients to be under the supervision of an orthopaedic consultant. We may refer patients to Mr David Harrison, for an opinion prior to the commencement of any treatment. Mr Harrison is a renowned specialist  orthopaedic spinal surgeon and Honorary Consultant at the Royal National Orthopaedic Hospital, Stanmore, who fully understands Dr Haje’s unique work in this field.

LOC^®pectus Treatment 

The treatment involves wearing a bespoke brace or orthosis called a "Dynamic Chest Compressor", as well as wearing the orthosis the patient must carry out daily exercises. During treatment the wearer must attend regular reviews at our clinic to constantly monitor and adjust the "Dynamic Chest Compressor" to ensure the correct correctional forces are beign applied. 

Dynamic Chest Compressor  

The Dynamic Chest Compressor is a custom made orthosis that is designed to an individual’s anatomy and to specifically treat their particular type of deformity. Its objective is to apply pressure over areas of the skeleton to remodel chest and rib bones. This concept is called Wolfe’s Law and is used in dentistry where braces are used to remodel the jaw. 

Length of Treatment 

Patients should be aware that treatment takes a minimum of 12 months to be effective and that adolescents are more likely to have a successful outcome because of the inherent flexibility of the chest wall at this age. However, older patients have been treated successfully. 

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The Initial Consultation

Because the success of the treatment is so dependent on the patient's compliance in following our treatment protocols and exercise regime, the initial consultation is Free. At this consultation we will establish a patient's suitability for treatment by carrying out a thorough assessment of your chest shape, discuss the treatment options and possible outcomes. We will explain the treatment protocols and procedures involved. We will also discuss Dr Haje's statistical evidence for achieving improvements in chest shape with The Dynamic Remodelling method. After the consultation there will be no obligation to proceed to treatment. 

LOC has prepared these treatment guidelines:

• The Dynamic Chest Compressor should be worn virtually all day during the first year of treatment and thereafter according to the clinician’s instructions.

• It is imperative that the Dynamic Chest Compressor is worn at night. However, it should be removed for bathing, swimming and any contact sports.

• Patients who have successfully followed the treatment plan developed by Dr Haje have enjoyed remarkable improvements to their chest shape.

• LOCpectus can provide the tools and advice to improve your Pectus Excavatum and Pectus Carinatum, but ultimately the most important factor in producing a successful outcome is the will power of the patient.

Exercise Programme

The wearing of the Dynamic Chest Compressor as detailed by the clinician and adherence to the exercise regime is essential for successful treatment. The exercise programme has been designed by Dr Haje to specifically target Pectus deformities.

Your LOC clinician will train you in each exercise and review your progress throughout the treatment. Without these specific exercises you will not enjoy the improvements in shape that are expected.

Measuring the change during treatment

During the treatment a series of pictures and 3D digital computer scans will be taken of your chest which will provide us with subjective and objective data of the improvements in your chest shape over time. Both the photographs and 3D scans will be sent to Dr Haje in Brazil. This allows him to review the progress of our UK patients and to give his expert opinion on treatment, brace adjustments as and when required. 

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Case Studies

Detailed below are the results of treatment of 2 compliant patients following treatment, for each of the 2 main types of Pectus deformities, Pectus Carinatum and Pectus Excavatum. Apart from significant improvements in their chest shape and correction of their deformities,they also had improvements in their psychological state. Following treatment they felt confident enough to go swimming and to sun bathe where as before treatment they never went outside without being totally covered.

Research Papers

Dr Haje has had a number of papers published in international journals. The non-surgical correction of Pectus deformities has also been endorsed by other medical professionals.

Pectus Carinatum successfully treated with bracing - case report. Haje SA.(International Orthopaedics 1993, vol.17(6):350-352)

Overcorrection during treatment of Pectus deformities with DCC orthoses: experience in 17 cases. Haje SA, Haje DP. (International Orthopaedics 2006, vol.30(4):262-267)

The Calgary protocol for bracing of pectus carinatum:a preliminary report. Kravarusic D, Dicken BJ, Dewar R, Harder J, Pocet P , Schneider M, Sigalet DL. (Journal of Pediatric Surgery 2006, vol.41(5) 923-926.

Pectus Excavatum and Carinatum: new concepts in the correction of chest wall deformities in the pediatric age group. Mavanur A, Hight DW. (Connecticut Medicine 2008, vol.72(1) 5-11).

About Us

LOC is a private orthotic clinic and was founded in 2004 by four clinicians who originally worked within the NHS. They ran a successful Orthotic department which had an international reputation as a centre of excellence in the field of Orthotics and Rehabilitation. LOC is committed to ensuring that its patients receive the very best treatment in a caring, open and professional manner.

Contact Us

To talk to one of our specialists or to book your Free initial Assessment:

Call:020 8974 9989 or E-mail: pectus@londonorthotics.co.uk

Location

LOC's Kingston clinic is conveniently located 3-5 minutes walk from Kingston mainline train and bus stations. It is only 25 minutes by train from central London and easily accessible from Heathrow or Gatwick airports. If you require a taxi we are happy to arrange this for you.

For details on how to find us please visit: Kingston Clinic Location  

Client facilities

• Free parking directly outside the clinic
• Fully air conditioned
• Free tea, coffee and spring water
• Child friendly
• Baby changing facilities
• Fully wheelchair accessible
• Disabled toilet 
• Free Wi-Fi connection (Network key on request)

© Copyright Statement: Images and information where supplied have been reproduced with the kind permission of Dr Sydney A. Haje, MD Medical Director, Centro Clinico Ortho : www.orthopectus.net, who owns the copyright to any images or text when supplied.  

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