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At Spire St Anthony’s we run a specialist chest wall clinic dealing with all aspects of chest wall problems including pectus deformities, as well as traumatic rib and chest wall injuries. The clinic is quite unique and allows an assessment by a team of specialists including an experienced thoracic surgeon, specialised orthopaedic surgeons, radiologists, pain specialists and chest physiotherapists.
At Spire St Anthony's Hospital we run a specialised pectus bracing clinic which offers a non-surgical outpatient based procedure to treat pigeon chest or pectus carinatum
What is Pectus Carinatum? Pectus Carinatum is the deformity of the sternum and rib cartilage that causes the chest to protrude outwards. This gives the chest a bowed-out appearance similar to that of a pigeon. Pectus Carinatum occurs due to a defect in the tough connective tissue (cartilage) that holds the ribs to the breastbone. This defect may be due to excessive growth of the costal cartilages in the rib. This growth occurs in the cartilage where the ribs and sternum (breast bone) meet. This growth causes the ribs and cartilage to collapse forcing the sternum outwards forming a pointed chest. This overgrowth of tissue can also push the sternum inwards which is called Pectus Excavatum. The deformity is often seen at birth but is more noticeable midway through childhood during growth spurts when the ribcage has grown and protruded further. Once the child has fully grown the anomaly remains the same. What causes Pectus Carinatum? The cause of Pectus Carinatum is unknown. However the condition is known to run in families suggesting it could be a genetic disorder. As with Pectus Excavatum, it can be associated with other conditions such as scoliosis and homocystinuria as well as inherited connective tissue disorders such as Marfan’s Syndrome, Ehlers-Danlos Syndrome and Poland’s Syndrome. Symptoms Pectus Carinatum is usually symptomless however it is not uncommon for people to be affected by the anomaly. The most common symptom is pain. This can be general chest pain or pain as a result of moving awkwardly or impact during physical activity. You may also experience tenderness and intermittent pain near the overgrown cartilage. Although internal organs develop normally, the deformity may prevent the heart and lungs from functioning optimally. Studies have shown that children with Pectus Carinatum may struggle to fully expire their lungs which can cause a reduction in stamina, even if they do not recognize it. It is more common for people, especially children, to suffer from psychological problems associated with the anomaly such as a negative self image resulting in a lack of self esteem and confidence. Treatment Chest deformities require time to correct and heal so it is important you receive a complete service throughout your treatment. At Spire St Anthony’s we have dedicated before and after teams to provide a comprehensive evaluation and treatment for those affected by Pectus Carinatum as well as other chest disorders such as Pectus Excavatum, rib deformities and chest wall tumours. After an initial consultation we will assess the most appropriate treatment methods for you. Whether it be invasive or non-invasive, we ensure your treatment will be of the highest quality, tailored to your individual needs. For the majority of cases, a brace will suffice in restoring the ribcage back to its normal shape however for more severe cases, surgery may be required. Brace A bracing system is considered the first line of treatment and is the preferred method to reshape the chest wall. A sleek, lightweight brace is fitted applying pressure to the ribcage gradually pushing the breastbone back into its normal position. The brace is customized to fit each person for maximum comfort and effectiveness. The brace allows unrestricted arm motion and can even be worn during physical activities (except for contact sports). For the brace to be effective it must be worn virtually everyday for 12 months along with daily exercises which will be instructed by your consultant. Surgery Surgery is usually only required for the most severe cases where a brace may not be sufficient in correcting the anomaly. Our surgeons use minimally invasive techniques which reduces scarring and recovery time meaning patients can return to regular activities as quickly as possible. Before deciding whether surgery is right for you, it is vital you seek the opinion of an experienced thoracic surgeon for a consultation. A consultation at St Anthony’s will consist of a thorough evaluation by an experienced thoracic surgeon who will diagnose and advise the most appropriate treatment for you. The Brace Clinic at Spire St Anthony’s Hospital Mr Ian Hunt Consultant Thoracic Surgeon offers this treatment at Spire St Anthony’s Hospital. To find out more about this procedure call us on 0208 335 4646 or complete our form on the right-hand side of the page.
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: email@example.com 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.
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