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Pectus Treatment

At the London Orthotic Consultancy, we are committed to providing personalised care for those with pectus deformities. Our non-surgical treatment for pectus carinatum involves a bespoke brace or orthosis called a dynamic chest compressor. For pectus excavatum patients we prescribe the Vacuum Bell which uses a vacuum pump to create an area of low pressure over the sunken part of the chest. We take a holistic approach to treatment and combine bracing therapy with a programme of daily stretching and breathing exercises to maximise treatment outcomes for our patients. We also offer rib flaring treatment to address protruding ribs which is often associated with pectus deformity but can also be an isolated issue. LOC has pioneered this method of treatment in the UK since 2010. We manufacture bespoke braces for each patient, ensuring comfort and ease of compliance during treatment.

NON-SURGICAL PECTUS TREATMENT

Length of Treatment

The majority of our patients enter into the treatment because they are unhappy with their chest shape. Therefore, we want you to be happy with the end result. Generally, we define the result and the time to finish the treatment by your own opinion of how your chest looks. This may range from you feeling comfortable enough to take your shirt off in public, or that you may simply no longer be aware of any deformity under your clothes. This is a very personal decision, but we will help to guide you through it. When treating patients with flexible chest walls, we have to be careful not to over-correct as some patients can show significant improvement within the first three weeks, hence the need for regular appointments in the early stages. To finish treatment, we generally need our patients to wear the brace in an ever-reducing 'wearing protocol'. For patients still growing, we will need to maintain treatment at some level until we are happy that an individual's growth has stopped. This may mean wearing the brace a couple of times a night during the week and continuing with exercises. On average, we would expect to have a positive outcome from treatment within a year. Once the treatment is complete and you have stopped growing, the deformity will not return.

Exercise Compliance

A patient's commitment to wearing their pectus brace, or using the vacuum bell, is a significant factor in achieving a successful result. As is committing to the prescribed stretching and breathing exercises. These tailored exercise programs actively enhance chest flexibility, while pressure exerted from specialised pads facilitates the remodelling of the chest. Each exercise regime is bespoke to each patient and created with both an orthotist and a sports physiotherapist. Our treatment programme typically 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. In the later stages of treatment, exercising with the brace on can also make the chest correction more stable and permanent. After completing bracing treatment or vacuum bell therapy, the majority of patients do not require ongoing exercises to maintain their new chest shape. It is our goal to help and encourage our patients as much as possible, but, ultimately, success will be determined by the patient themselves.

Pectus Therapy Yoga classes

As part of our treatment programme, we offer our patients access to online yoga classes designed specifically for pectus patients to complement bracing and vacuum bell therapy. These classes are run by Alva Yoga and encourage correct breathing, posture and stretching while complementing the bracing itself. The main objective of these yoga exercises is to lengthen the spine, increase flexibility and improve mobility, all of which will promote a better posture.

Swimming

Swimming is also a great way to exercise when you are undergoing treatment for a pectus deformity as it helps to stretch your chest and increase its flexibility. Swimming styles like backstroke and front crawl encourage you to take deep breaths which promote chest wall correction. Note that swimming butterfly stroke is not recommended as it can compound the problem when the arms swing together and compress the chest.

Surgical treatment

In the past, with severe cases of pectus excavatum and pectus carinatum, surgery might have been recommended by the NHS. This is a major procedure, and, as with any type of surgery, there are risks attached. Most NHS trusts no longer recommend surgery for pectus carinatum and pectus carinatum as the conditions are considered to be cosmetic and no threat to physical health. The type of surgery performed privately in the UK is either the Nuss or Ravitch procedure. The Nuss procedure is minimally invasive compared to the Ravitch. Good results have been reported from both types of surgery and patients are generally pleased with the improvement in chest shape. These procedures, however, do not address the problem of rib flaring, which is fairly common, and patients can be left with visible surgical scarring.

Locations:

Kingston upon Thames (HQ) Cambridge Bristol Manchester

Pectus FAQs:

What's the best age to start chest bracing treatment?

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.

What outcomes can pectus patients expect from bracing treatments?

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.

How often do I need to come in for check-up appointments?

Regular reviews are part of the treatment programme, preferably in clinic with one of our specialist orthotists, or via Skype 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 ensure 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.

How visible is the chest brace under clothing?

This is a very common concern for patients considering treatment; in general, the 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.

Can I exercise when going through chest bracing treatment?

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.

Will I need more than one chest brace throughout treatment?

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.

What advice would you give to people considering treatment?

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.