How Painful Is Pectus Carinatum Treatment?

Pectus carinatum, also known by the names pigeon chest or pouter pigeon breast, is a relatively common congenital condition which affects around 1 in every 1500 births. [1] Although present from birth, it often does not become obvious until the early pre-teen to teenage years. Pigeon chest results in an overgrowth of the cartilage forming the breastbone, which results in the breastbone poking out from the chest. It is up to five times more common in males compared to females [2,3]; however, its causes are largely unknown. 

There are several treatment options available for pectus carinatum. In very mild cases, physical therapy sessions and exercises may be prescribed. These aim to strengthen weak chest muscles and may help with the chest’s appearance. 

The second treatment and most common option is the use of an orthotic brace specifically designed to treat this condition. This can be used in most cases of pectus carinatum, and is often quite successful. 

The third and final treatment option is surgery. It is usually only recommended in the most severe cases of pectus carinatum, or in the rare instances where bracing treatment cannot help. One common surgery technique is the Ravitch procedure, which is an invasive surgical procedure and can take several months to fully recover from. Consequently, the use of an orthotic brace is recommended as the first line of treatment in the vast majority of pectus carinatum sufferers [4]. 

How Bracing for Pectus Carinatum Works

Orthotic bracing for the treatment of pectus carinatum works in a similar way to dental braces used to realign teeth. During the adolescent years (pre-teen to teen), the breastbone is principally composed of cartilage; hence it is still relatively flexible and malleable. Later in life (between around 20-25 years), various parts of this cartilage begin to be converted to bone (this process is known as ossification). 

However, we can take advantage of the breastbone malleability during childhood, through the use of a lightweight brace which applies pressure to the protruding breastbone region. This continued pressure slowly reshapes the breastbone cartilage and trains it to grow in the desired shape. Over time, the brace pressure can be reduced and finally removed. Generally, the younger that bracing treatment is started, the better the final results will be [5]. Often children as young as 10 years old can begin treatment. 

How Long Will Your Child Have to Wear a Pectus Brace? 

Unfortunately, treatment of pectus carinatum is not a short-term process. Furthermore, it is important to closely follow your health professional’s instructions to avoid possible relapse of the condition. Depending on the severity of your child’s pectus carinatum, bracing is usually started at a lower pressure (2.5-3 PSI), which can be increased if required [6]. More severe protrusions will require higher brace pressures. Once a suitable pressure is established, it will usually take 6-12 months to remodel the breastbone to the desired shape [7]. During this time, the brace will have to be worn for extended periods, perhaps up to 23 hours per day. Your treating health professional will instruct you on the required frequency, taking into account your child’s age and the severity of their condition. 

After the breastbone cartilage has been successfully remodeled to the correct shape, the child can move to maintenance bracing. In this stage, the brace is worn for reduced periods (often around 8-12 hours/day) until skeletal growth ceases. The maintenance period is usually one to one and a half years long; however, it may vary from patient to patient. As long as the maintenance period is successfully completed, relapse or recurrence of pectus carinatum later in life is quite rare.

Is Using a Pectus Carinatum Brace Painful?

In general, treating pectus carinatum with an orthotic brace is not painful. This is particularly true if your child starts bracing treatment at a sufficiently young age. However, wearing the brace for extended periods may be uncomfortable, particularly at the beginning of the process. However, this process is much preferable to invasive surgery methods, which require most patients to take painkillers for at least several weeks afterward. 

If the compression pressure is too high, this may lead to unwarranted discomfort or skin lesions. If you feel that the brace pressure may be too high, you should speak with your treating healthcare professional. However, one of the main factors which can make the process more comfortable for your child is investing in a custom-made orthotic brace. Generic or poorly fitting braces often cause discomfort due to unevenly applied pressure, and are one of the most common causes of patient complaints [6]. Moreover, generic braces typically have metal components that cause discomfort, while the custom Dakota braces are made with a much more comfortable adjustable nylon.

This is where custom braces produced by Dakota Brace can help. All of our braces are custom-made for each patient, using a 3D scan of their chest to ensure a perfect fit. Furthermore, we use the latest 3D printing technology to match the brace shape to the patient’s chest shape, while reducing turn-around time. There is a high level of quality control in the process, with every step performed under the supervision of our team of certified clinicians. 

Expected Outcome of Pectus Bracing

The majority of patients who use bracing to treat pectus carinatum are quite satisfied with the results. As previously mentioned, recurrence of pectus carinatum following the maintenance bracing period is quite rare. Clinical studies show that less than 10% of patients fail to respond to bracing treatment [8,9]. Furthermore, many of these cases of failure are in the more severe form of pectus carinatum, known as chondromanubrial prominence. Overall, bracing treatment has been shown to significantly improve patients’ quality of life and self-esteem [8]. 

Conclusion

Are you ready to restore your child’s health and confidence? Or would you like more information on treating pectus carinatum with a specialized orthotic brace? Click here to schedule a free consultation with a Dakota Brace health professional. Even better, we’ll give you $75 off your first order with us. Get evaluated for our Custom Pectus Brace — The Original Dakota Brace today! 

References

1. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
2. Cobben, J. M., Oostra, R. J., & van Dijk, F. S. (2014). Pectus excavatum and carinatum. European Journal of Medical Genetics, 57(8), 414-417.
3. Abdullah F, Harris J (2016) Pectus excavatum: more than a matter of aesthetics. Pediatr Ann, 45:e403–e406.
4. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.
5. Martinez-Ferro, M., Fraire, C., & Bernard, S. (2008, August). Dynamic compression system for the correction of pectus carinatum. In Seminars in pediatric surgery (Vol. 17, No. 3, pp. 194-200). WB Saunders.
6. Emil, S. (2018). Current options for the treatment of pectus carinatum: When to brace and when to operate?. European Journal of Pediatric Surgery, 28(04), 347-354.
7. Lee, R. T., Moorman, S., Schneider, M., & Sigalet, D. L. (2013). Bracing is an effective therapy for pectus carinatum: interim results. Journal of Pediatric Surgery, 48(1), 184-190.
8. Colozza, S., & Bütter, A. (2013). Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. Journal of Pediatric Surgery, 48(5), 1055-1059.
9. Emil, S., Sévigny, M., Montpetit, K., Baird, R., Laberge, J. M., Goyette, J., ... & Courchesne, G. (2017). Success and duration of dynamic bracing for pectus carinatum: A four-year prospective study. Journal of Pediatric Surgery, 52(1), 124-129.