Chest bracing gives excellent results for teenage pectus carinatum patient, Ben, who achieved a flat chest after only six months.
Feeling self-conscious about your appearance is almost a rite of passage for teenagers today, but for young people with pectus carinatum, these feelings and anxiety can be worse.
Ben,* a 14-year-old patient, came to The London Orthotic Consultancy’s Kingston clinic for treatment for his pectus carinatum inferior with rib flaring after only being offered surgical solutions on the NHS. While surgery is a well-established method of treatment, it carries the associated risks of having a general anaesthetic and does not address the problem of the flaring of the ribs. Patients can also be left with visible scarring.
“He was 14 at the time and was eager to find a non-surgical treatment option to improve the appearance of his chest wall,” says clinician Sam Walmsley.
“His age made him an ideal candidate for our non-surgical bracing treatment, as the chest is more flexible and malleable in adolescents than adults and becomes stiffer as the skeleton matures, which can make results harder to achieve.”
Sam Walmsley, LOC pectus specialist
Ben’s treatment involved wearing a bespoke brace, the dynamic chest compressor, which applies constant pressure over the area of his chest that needed to be remodelled. Because pectus carinatum is caused by the chest protruding, we use a brace that fits over the apex of the chest to push it in, the slimline dynamic chest compressor, for the upper chest.
In cases where the ribs also protrude (like with Ben’s), we recommend a rib flaring brace, too. As you push the upper chest inwards, the ribs tend to flare out, hence we use this lower brace to push the ribs back in. In addition, we prescribed him a programme of daily breathing and stretching exercises to follow.”
Pectus carinatum, also known as ‘pigeon chest’, is a congenital deformity of the anterior chest wall. It occurs when the breastbone (sternum) is pushed outward by an abnormal overgrowth of cartilage. This can cause visible protrusion of the bone and, in some cases, other related symptoms, such as respiratory problems.
It affects around one in 1,500 people, and although present at birth, it often becomes more noticeable in early adolescence when the ribcage and the rest of the body undergo growth spurts during puberty.
Length of treatment varies depending on the age of the patient, the elasticity of the chest and the severity of the condition.
“His treatment here at The London Orthotic Consultancy lasted a period of 15 months, however, he successfully achieved a flat chest after only six months,” says Sam. “The remaining nine months consisted of night-time brace use only, in order to maintain the much-improved appearance throughout his growth spurts.”
You can see Ben’s before and after photographs here, which show significant improvement in the appearance of his chest.
*Patient’s name has been changed as he preferred to share his testimony anonymously.
This depends on a few factors:
Early adolescence (roughly between the ages of 12-16 years old) is an optimum age to start treatment. This is because 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 can prevent a deformity from getting worse 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 it’s to avoid surgery, improveme the appearance of the chest shape, or reduce rib flaring etc.
All these goals are taken into consideration during your first pectus 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.
Regular reviews are part of the treatment programme, preferably in clinic with one of our specialist orthotists, or via video 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 make sure 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 slimline 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.
Correct your chest shape without surgery with the slimline dynamic chest compressor and rib flaring brace. We’re proud to have pioneered this treatment in the UK since 2010 and have achieved outstanding results for our patients.
We’re happy to answer any questions you might have, with no commitment to proceed with treatment.
