Excavatum Case Histories

LOC is a pioneer of non-surgical treatment for pectus excavatum in the UK. We are proud to have achieved positive results for our patients. We are grateful that several of our patients and their parents have given us permission to share their scans.

We treat pectus excavatum conservatively with a bespoke orthosis known as the dynamic chest compressor, in combination with vacuum bell therapy, together with a daily exercise programme. The compressor helps to correct rib flaring, a common symptom of pectus excavatum. The vacuum bell works in tandem by creating a vacuum over the depressed sternum area to lift the sunken part of the chest out.

Other anatomic hallmarks of pectus excavatum include flared ribs, pot belly and rounded shoulders due to poor posture, all of which can become more prominent as a child or teenager grows older.  

PATIENT A

Treatment type: Vacuum Bell Brace, Rib Flaring Brace

Great results with a combination of two braces for this Pectus Excavatum patient. With an increase in compliance, you can notice some bruising where the dynamic chest compressor sits over the ribs.

Bruising can differ from patient to patient and usually is a good sign indicating pressure has been applied and compliance is high. LOC clinicians will keep an eye on progress with skype call to see if 'too much' pressure has been applied. This is usually advised via the ratchet systems on our straps.

Above: before treatment & after treatment side by side

Above: before treatment & after treatment side by side

PATIENT B

Treatment type: Excavatum Brace

Patient B came to us when he was 19 years old. His first appointment was 26/06/2015 and his last appointment was 11/08/2017

PATIENT C

Treatment type: Carinatum Brace

Patient C came to us when he was 15 years old and the length of treatment was one year.

Get in touch

If you think you or your child is showing signs of pectus excavatum and would like to have an assessment, we offer a free, no-obligation first consultation.

In this consultation, a LOC clinician will examine all aspects of your chest and posture, and assess whether treatment is necessary and whether your chest wall is flexible enough to respond to treatment.

For more information about the condition, you can visit our pectus excavatum page, or contact us to book your free initial consultation today.

Pectus FAQs:

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

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