Pectus excavatum is the most common chest deformity. According to Dr. Haje, there is a case of
pectus for every 100 children he examined. The deformity isn’t just cosmetic. It also causes
psychological problems in most people, making them keep to themselves.
Unfortunately, the deformity affects all areas of life. Most patients feel embarrassment, shyness,
limited exercise capacity, and frustration. Although this is a prevalent deformity, there is still a
lack of information about the treatment options, such as bracing.
How to Treat Pectus Excavatum
Pectus excavatum can be treated:
Surgically
Non-surgically
The most used surgical technique is the Nuss procedure. Even though this technique is effective,
it still comes with side effects. Dr. Nuss doesn’t recommend surgery in very young patients
because of the potential risk of relapse after removing the Nuss bar.
Non-surgical methods such as bracing and vacuum bell therapy are practical, proven ways to
improve pectus excavatum non-surgically.
How Bracing Improves Pectus Excavatum
Bracing applies progressive external force on the flared ribs that often come with pectus
excavatum. This type of treatment is more known for patients with pectus carinatum. However, it
is scientifically proven to be highly effective in patients with pectus excavatum.
Specific physical exercises are also used to increase the effectiveness of the method. The most
critical factor in a successful treatment is chest flexibility and consistency in application. Even
though this method is relatively unknown to the public, scientific publications by researchers
show impressive results.
Law in Orthopedics
The non-surgical treatment of pectus excavatum with braces is based on Nicolas Andry’s
principles of bone remodeling. He is the “father of orthopedics.” His book, published in 1741,
explained that bone and cartilage are flexible substances, and external forces (in our case,
bracing) can remodel them. This is accepted as a law in orthopedics, known as the law of bone
remodeling. Applying a gradual external pressure to the deformed bone structure can remodel the
chest wall.
32 Years of Studies
A 32-year study collected data from 4012 patients with pectus deformities from 1977 to 2009.
The study showed a direct connection between pectus deformity and orthopedics. Researchers
concluded bracing was an effective alternative to surgery in correcting pectus excavatum.
Researchers said bracing could bring exceptional outcomes in one, two, or more years,
depending on how well the patient follows proper directions.
According to researchers, the best-proven method to improve pectus excavatum is the
combination of compression to the costal edges (flared lower ribs that often come with pectus
excavatum) and increasing the intrathoracic pressure by exercising and breathing while wearing
a brace.
There are a few factors that can predict success.
Chest wall flexibility
Type of pectus excavatum (broad or localized)
Age
How disciplined is the patient in applying the brace
Correct guidelines for treatment given by the therapist
It has been concluded that the flexibility of the deformed bones and cartilage is more critical than
the deformity severity for bracing to succeed. You can do a test to determine the flexibility.
Test
Take a deep breath and squeeze the abdominal muscles. Hold the air in like you’re about to get
punched. This will increase your intrathoracic pressure. Then, the tester should manually
compress your flaring of both lower ribs. It is considered flexible if the protrusion reduces.
Surgery or Bracing?
According to Dr. Sydney Haje and Dr. Davi Haje, if the patients are still growing, they should
first try a non-surgical method of improving pectus excavatum.
This method is low risk, proven effective, and the patients can always change their minds if they
are satisfied or need to be disciplined to follow it. With the Nuss procedure, you will need to live
with the Pectus bar inserted below your sternum for a few years.
The treatment of pectus excavatum involves understanding basic orthopedic
concepts. Prescribing a brace to a patient doesn’t mean successful treatment of the deformity. The
patient must follow a protocol to achieve a successful treatment.
Bracing for Adults
According to research, bracing can be effective in adult patients with pectus excavatum.
However, it is essential to know that it can be more complex compared to younger patients, but
still possible. The chest wall flexibility is most important, and you must do the test before
treatment. Adults can be more consistent and motivated to apply the brace than kids. That can be
very advantageous.
Overcorrection Is a Proof of Effectiveness
According to research published in 2006, overcorrection in patients with pectus excavatum who
use braces can happen. Out of 1824 patients with pectus deformities, overcorrection occurred in
- However, the overcorrection was easily corrected. It is essential to know that the treatment
with braces was successful in all 1824 patients.
Overcorrection shows how effective bracing can be in improving pectus excavatum non-
surgically. According to research, the most common side effect of bracing is overcorrection. This
happens to highly motivated patients with flexible deformities.
Conclusion
Bracing for correcting pectus excavatum is proven to be effective. The risk of complications is
minor, and the success rate is high. You can also combine bracing with other non-surgical
methods for improving pectus excavatum, such as vacuum bell therapy.
This will speed up the improvement process. It is important to know that wearing the LA Rib
Flaring Brace won’t fix your deformity magically. It would be best if you still were disciplined
and motivated to see great results non-surgically. Thank you for reading!
About the Author
Mihail Veleski is the CEO at PectusExcavatumFix.com. Established in 2015, Pectus Excavatum
Fix has helped thousands of people with sunken chests improve their deformity, both physically
and mentally.
I pride myself on ensuring the information and methods I share are tried by me, correct, and
backed by research. I personally improved my concave chest and rib flare deformities non-
surgically.
Sources
Wolff’s law. In: Wikipedia [Internet]. 2022 [cited 2023 Feb 9]. Available from:
https://en.wikipedia.org/w/index.php?title=Wolff%27s_law&oldid=1116135964
Vacuum Bell: What It Is, Therapy, Risk & More [2023 Updated] [Internet]. 2019 [cited
2023 Feb 9]. Available from: https://pectusexcavatumfix.com/vacuum-bell-therapy/
Haje SA, de Podestá Haje D. ORTHOPEDIC APPROACH TO PECTUS
DEFORMITIES: 32 YEARS OF STUDIES. Rev Bras Ortop. 2015 Nov 16;44(3):191–8.
HAJE DDP, HAJE SA, VOLPON JB, SILVA ACOD, LIMA LFB, HUANG W.
LOCALIZED PECTUS EXCAVATUM TREATED WITH BRACE AND EXERCISE:
LONG TERM RESULTS OF A BRAZILIAN TECHNIQUE. Acta Ortop Bras.
2021;29(3):143–8.
Top 3 Pectus Excavatum Braces In [2023]: Real User Opinion [Internet]. 2015 [cited
2023 Feb 9]. Available from: https://pectusexcavatumfix.com/pectus-excavatum-braces/
Haje D de P, Haje SA, Volpon JB, da Silva ACO, Lima LFB, Huang W. BROAD
PECTUS EXCAVATUM TREATMENT: LONG TERM RESULTS OF A BRAZILIAN
TECHNIQUE. Acta Ortop Bras. 2021;29(4):197–202.
Dynamic Remodeling Method [2023]: Fix Pectus Non-Surgically [Internet]. 2022 [cited
2023 Feb 9]. Available from: https://pectusexcavatumfix.com/dynamic-remodeling-
method/
Haje S. ABORDAGEM ORTOPÉDICA DAS DEFORMIDADES PECTUS: 32 ANOS
DE ESTUDOS. Revista Brasileira de Ortopedia. 2009;44(3):191–8.