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Non-Surgical Treatment



Conservative methods of treatment may be helpful in some cases, however the results from the reported studies are questionable due to the small sample size and unavailability of long-term results.



Psychological Support and Counselling
Parental attitudes toward disability seem to be a particularly important determiner for a child's adjustment to disability (Pringle 1964, as cited by Anderson, 1982). This statement is also true for patients with a pectus anomaly.

Some parents dismiss the pectus anomaly as being part of the person, for example colour of hair or eyes. This allows the child to grow up believing he/she is no more different than the next child. However other parents do seem to draw attention to the anomaly and heighten anxiety.

Although this may be difficult, especially if the pectus anomaly is severe, parents of young children should encourage acceptance of their child's chest shape and develop coping strategies so that their child can adapt with their anomaly. More importantly it may allow avoidance of major surgery later in life.

However for some patients further help is needed and many may benefit from psychological support and counselling. Einsiedel, E. & Clausner, A. (1999) state that if patients with psychological problems, for example inadequate coping strategies and neurotic reactions, do not have psychotherapeutic help, these problems persist and even increase over time.



Physiotherapy and Posture Improvement
Physiotherapy and posture improvement programs may certainly help patients with pectus anomaly. Many patients have rounded shoulders and a slouching posture and would benefit from posture improvement exercises, with or without additional surgical correction. However body-building type exercises usually result in worsening of the cosmetic appearance due to the enhancement of the pectoral muscles. Similarly in female patients breast development or artificial enhancement can merely make the asymmetry of the underlying ribs more obvious.

Further information on conservative treatment can be found on www.orthopectus.com.br



Silicone Implant
In the past plastic surgeons have inserted customized silicone implants beneath the skin to fill the hollow in pectus excavatum. The results were poor, some slipped and a durable improvement was not obtained. Because of this, this treatment is no longer used.



Vacuum Bell Therapy

Only available in Germany.
This is an experimental approach which offers a non-surgical solution to pectus excavatum. It works by pulling the depressed chest forwards and, by holding this position and with treatment over a few years, to re-shape the chest. A suction cap is placed over the depressed area and a vacuum is created between it and the underlying chest wall. A patient-activated hand pump is used to reduce the pressure up to 15% below atmospheric pressure. It is suggested that the device be used for a minimum of 30 minutes, at least twice a day. It may be used for a maximum of several hours each day. Excessive negative pressure or more prolonged application can cause bruising and swelling with damage to the chest wall.

Presently, the daily treatments are recommended for 12 – 15 months. Some successes have been reported in young children. However, at present its place in the management of older people and the durability of any improvement reported is not known. This therapy is not offered in the UK, however, there is a company in Germany which sells the device. You must discuss this option with your GP prior to purchasing the device (Haeker, FM & Mayr, J. 2006).



Bracing
  • Must be worn over a T-shirt for 14 to 16 hours a day for a minimum of two years or until full height is reached.


  • Although there are some advocates for a variety of braces, there is no evidence that these slow the progression of the chest deformity, nor do any of these improve it. There is no harm in trying this approach, but it may be uncomfortable.


  • Only available in USA.



  • Bio-Alcamid (Restalyne)
    Comprises 96% water and 4% Synthetic reticulate polymer (poly-Alkyl-Imide). This blend guarantees softness to the touch; the implant has a similar consistency to the surrounding tissues without causing unsightly visible or palpable effects of artificiality.