Common questions about the Pectus bracing clinic for treatment of Pigeon Chest
Is bracing suitable for every one with a pectus carinatum or ‘pigeon chest’ deformity?
The technique is aimed at treating most patients, male or female with this type of deformity. However, there are two important considerations: Age and what is called ‘musculoskeletal maturity’.
Because the technique relies on firstly manipulating the soft cartilages joints between the breastbone and ribs (the origin of the pectus deformity) and then holding them in position with the brace to allow re-modelling; age is important. As we get older these cartilaginous joints become increasingly stiff and bone-like making manipulation and brace correction more difficult. Some people ‘age’ at different rates and so even though they may be in the late teens or early 20’s they still may have some flexibility in these joints and of course vice versa.
So is there an age limit for treating pigeon chest with a brace?
The manipulation and custom bracing technique is best suited to patients aged between 8-21 years of age. The brace can occasionally be offered in patients older though the result with bracing alone may be less effective. However, combined with minimal access keyhole surgery a ‘hybrid’ procedure may be suitable and of course we offer the more traditional surgical operations to correct the pigeon chest.
Are there any other reasons I am not suitable for this technique?
One reason is that you have been miss-diagnosed, and that you don’t have a pectus carinatum. The expert assessment prior to going on with a manipulation and brace ensures the correct diagnosis and the correct treatment offered.
Do I need did specific investigations?
No, generally not. Occasionally though if we are not certain of your pectus diagnosis a radiological investigation to assess further will be requested but this is not usual
Is it painful?
The manipulation performed to flatten or reduce the deformity is an important and unique part of the technique we use to treat the pigeon chest. We have developed this technique and are currently the only pectus treatment group using this method. It is performed as an outpatient procedure. The actual manipulation and reduction of the cartilage joints between the breastbone and ribs takes around 30-45 minutes and is done gently as possible. It is like a very deep massage of the chest and pushes the cartilage back in to the correct alignment. It is uncomfortable and sometimes painful but we use a combination of local anaesthetic cream and ‘gas and air’ (Entonox) to help relieve the pain during the procedure. Gas and air is used for many sorts of minor procedures often in the A&E department.
Will I need regular painkillers?
Usually for the post few days we would recommend taking simple painkillers like ibuprofen regularly, the pain quickly wears off and no painkiller is usually needed after the first 5 days.
Is the brace custom made?
Yes, the brace is made after the assessment and involves taking chest measurements and then we create a custom fitted brace. This takes around 30 minutes and includes a fitting following the manipulation.
Why do I have to come back the next day after bracing?
The day after the manipulation, custom fitting and bracing we arrange to see you the next day for a further assessment. This is to check the brace and its fit to make any adjustments and to check the skin. At that point we will go through the personalised bracing program.
How long do I wear the brace after first bracing?
Advice will be given and is determined by severity of the deformity but in general the brace is worn continuously for the first 5 days. On the fifth day, we recommend a 15-minute break for a shower and a skin inspection. After that the brace is worn almost continuously for 3-4 months with 15 minutes break per day for showering.
Can the skin be affected?
Where the brace touches the chest, the skin can be affected and care particularly in the first few weeks should be taken to avoid a skin problem such as a pressure sore. Advice will be given about what to watch for and how to look after your skin whilst wearing the brace.
Is the brace visible under my clothes?
The brace has a low profile but as each brace is custom fit, depending on your type of deformity may be more or less noticeable. In general, it will be noticeable if only a T-shirt is worn but not if more layers such as a baggy jumper or coat is worn. But remember, your pectus deformity may have been as equally noticeable.
How many times do I need to be seen?
The pectus bracing program lasts around a year, and we recommend that we see you 2 to 4 times after the first consultation to assess progress, adjust the brace fitting and give advice around reducing the amount of time the brace are worn. After the first 4-month review, we would often (but not always) recommend reducing the brace wearing by several hours each day.
How long do I have to wear the brace for?
The brace is worn in most patients for around a year, but by 8 months most will only be wearing the brace at night time when sleeping. However, there is some variability around the time needed to correct the pectus and sometimes it may be required to be worn longer defending on the severity and response to treatment.
Can I see play sport?
The brace can be worn during sports and exercise though there are some restrictions around contact sports such as rugby or martial arts as there is a risk during contact (to the opposition). In general, we recommend not wearing the brace during such sports but as the brace is only worn permanently in most for the first 4 months, usually after this time you are able to tailor periods when not wearing the brace around such sports activities.
What about swimming and other water sports?
Swimming is probably best avoided, as continual immersion in water will affect the ‘wear and tear’ of the brace. Remember, once the first 4 months is completed most will be able to start wearing the brace less often and with period’s off when they are able to play any sport include swim.
How much does it cost?
The overall cost of the pectus-bracing programme is designed to be affordable and certainty when compared to the cost of dental bracing is very competitive. For further information and details on the cost of the bracing programme please contact St. Anthony’s Hospital and speak to the Treatment Enquiry Team on 020 8335 4646 or contact Mr Hunt’s secretary (Monika) on 0208 725 3278 or via Email: firstname.lastname@example.org
When is the next pectus bracing clinic?
The pectus bracing clinic is a highly specialised clinic run only 4 times a year and places are limited due to length of each consultation. For details of the next clinic, please check out the St. Anthony’s Chest Wall clinic webpage or alternately contact the enquiry team.
If the brace is not the right treatment for my pigeon chest is there alternative options?
Our experienced consultant thoracic surgeon who treats all types of pectus deformity and runs the clinic will only offer you the brace if he thinks it will be the right option for you. Alternative options including a ‘hybrid’ procedure involving minimal access keyhole surgery together with bracing can be considered as well as more traditional surgical approaches. This will be discussed with you during your consultation.