Pectus Deformity Q&A with Sam Walmsley
American swimmer Cody Miller has it. Former Dutch swimmer and triple Olympic champion Pieter Hoogenband has it. Many other celebrities are also purported to have it, in varying degrees of severity.
Indeed pectus deformity is incredibly common. So common, in fact, that approximately one in 300 people suffer from slight to severe pectus excavatum, while pectus carinatum affects one in 1,500 people. It’s more frequent in men and tends to become apparent during adolescence, even though it is congenital (in other words you have it from birth).
Despite this, there’s a distinct lack of literature on the subject. It’s also considered cosmetic by the NHS and surgery is dealt with on a case-by-case basis – the expectation for many patients is that they should simply put up with it.
At LOC, we do not carry out surgery. Instead, we have a different approach, pioneering the use of bracing and non-surgical treatment. No matter how mild the condition, if it’s affecting a person’s confidence and can be improved with a bracing orthosis, then we can help.
We spoke to clinician Sam Walmsley to find out more about the whats, whys and hows of pectus deformity and LOC’s treatment.
What does pectus deformity look like?
Pectus conditions can be broadly separated into two main categories, though there are a range of mixed, or more complex, types. The two most common are pectus excavatum, or ‘sunken chest’, which is distinguished by the breastbone, or sternum, pushing inwards, and pectus carinatum, also known as ‘pigeon chest,’ where the breast bone protrudes outward. They are treated slightly differently, although both can be treated with surgery, non-surgical bracing or a combination of the two.
What causes pectus deformity and why?
The exact causes aren’t known. Generally, pectus excavatum is thought to be caused by excessive growth of the rib cartilage in the chest, between the bony ribs and the breast plate. Excessive cartilage growth occurs during adolescent growth spurts, which can mean minor pectus deformity sometimes becomes exaggerated in teenage years. Severity can differ greatly from person to person, ranging between a small indent to the sternum sinking several centimetres into the vertebral column.
Is it genetic?
Patients usually have family members with a pectus deformity – roughly 40% – although a direct genetic marker is yet to be fully identified. Genetic disorders, such as Marfan syndrome, increase the likelihood of having pectus deformity.
Are there any other physiological problems caused by pectus deformity?
Any sign of pectus deformity can normally be diagnosed by physical examination. Poor posture often comes hand-in-hand with pectus deformity; the shoulders may slump forward and a patient may also present other spinal curvature issues, such as scoliosis. It’s also common for abnormalities of the ribcage – or ‘rib flaring’ – to appear, when the lower ribs are pulled upwards and poke out. Sometimes rib flaring can make the overall appearance of the deformity seem worse. An apparent pot belly and rounded shoulders can also be hallmarks of pectus deformity.
Though many patients show no other symptoms, aside from their abnormal chest shape, there remains debate in the medical community about the existence of other complications, for example shortness of breath, and further studies are required. Complaints of those with pectus excavatum can include chest pain, aggravated by exercise, and generally a tightness across the chest. Anecdotally, some patients say that they do not feel as fit as, or don’t have as much stamina as, their peers.
What about the psychological impact?
Some people find that their pectus condition does little to affect their confidence. Others may be desperate to seek treatment in the hope of one day feeling comfortable taking their top off, visiting swimming pools, the beach or looking for a partner. Low self-esteem surrounding physical appearance, especially during adolescence, can lead to sufferers becoming withdrawn, anxious, insecure, or worse, clinically depressed.
Often, the psychological effect is more severe than the physiological inconveniences of pectus deformity and is reason enough to seek treatment. The increasing number of pectus surgeries seems to acknowledge the severity of psychological distress it causes some patients.
What does surgical treatment involve?
We would recommend that anybody considering surgery should have a consultation with a thoracic surgeon to see what they would recommend for their particular chest shape. There are a number of proven surgical approaches that can be taken. As with any major surgical intervention there are risks attached and there is quite a long period of rehabilitation and physiotherapy. In the first months following surgery for example, patients are advised not to lift heavy objects, lie on their side or sit in a slumped position. Patients must also avoid swimming until the wound is well-healed and refrain from driving for at least three months.
What does non-surgical bracing involve?
Our non-surgical treatment is based upon the pioneering work of the late Dr Haje, who demonstrated that chest wall deformity could be improved with a combination of bracing and exercise. We have found that bracing is very successful for both pectus excavatum and carinatum, as long as the patient is an adolescent or an older patient with a flexible chest and importantly, as long as they adhere to our recommended treatment programme(including breathing and stretching exercises). The Dynamic Chest Compressor is a bespoke orthosis that uses pressure to remodel and correct chest shape. A second brace may aid flaring ribs, although it must be worn for 23 hours a day, with a break for showering.
We also offer Vacuum Bell treatment, which uses a silicone cup and vacuum to create an area of low pressure. This helps to raise the sternum upwards in patients with pectus excavatum. The braces are relatively subtle. For example, you would be unlikely to notice them under a baggy t-shirt.
So, you just have to wear the braces?
All bracing treatment requires a patient to adhere to 30-40 minutes of exercise a day, in conjunction with stretching and breathing techniques which keep the chest wall supple. Activities such as yoga, swimming and Theraband™ stretching are all hugely helpful in keeping the chest wall flexible.
How long does treatment take?
Inevitably treatment time will vary depending on the severity of the deformity.
For pectus carinatum, we expect a positive outcome within about eight months, and sometimes results can show in a few weeks. Pectus excavatum treatment will normally take longer but we would expect to start seeing results after a year. We tend to measure success and the end of treatment at the moment our patients feel confident enough to remove their shirts in public.
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If you would like to know more about LOC pectus bracing treatment feel free to give us a call on 020 8974 9989 or use our contact form to book your FREE initial consultation. Join our Pectus community on Facebook @LOC.Pectus