Chest Wall
Bracing

Bracing applies sustained, adjustable pressure to the chest protrusion to gradually remodel the chest wall into a more natural shape. Like orthodontic braces for teeth, it works by harnessing the flexibility of the cartilage over time — and requires consistent daily wear to be effective. The brace is custom-made from a 3D scan of each patient's chest.

Alongside standard dynamic compression bracing, Mr Hunt offers a preparatory manipulation technique before the brace is fitted. Using physiotherapy soft tissue release principles — adapted specifically for the chest wall — it gently mobilises the cartilage joints of the breastbone towards a more corrected position before the brace is placed. The clinic's published outcome data shows this improves compliance and can reduce the total programme duration. It is offered where clinically appropriate, not in every case.

Yes. The American Paediatric Surgical Association (APSA) reviewed the evidence in 2012 and recommended external bracing as the first-line treatment for flexible pectus carinatum. The Pectus Clinic collects outcome data and has published results in peer-reviewed journals and at national and international conferences.

Not always. Three factors matter most: age, chest wall flexibility, and the type of deformity. Bracing is most effective in younger patients with flexible cartilage, and becomes progressively less predictable as the chest wall stiffens with skeletal maturity. High carinatum — where the protrusion is in the upper chest — can be harder to treat with a standard brace. Mr Hunt assesses all patients individually, using clinical examination, a 3D scan, and a pressure gauge to confirm suitability before recommending treatment.

Bracing is primarily a treatment for children and adolescents — the majority of patients at the Pectus Clinic are in their early to mid-teens. The chest wall stiffens with skeletal maturity, and the effectiveness of bracing reduces progressively with age. Results can be achieved in older patients in selected cases, but realistic expectations are important and the programme is likely to take longer. Mr Hunt will give an honest view of likely benefit at the initial consultation.

Rib flare — where the lower ribs protrude prominently — is common alongside pectus carinatum, and in younger patients it often improves naturally over time with growth and targeted exercises. Exercises are a routine part of the bracing programme regardless. Where flare is more significant, a rib strap can be added alongside the main brace. For more prominent or persistent rib flare, a custom rib flare brace may be recommended. Mr Hunt assesses this at consultation.

The consultation is around 30 minutes and can take place virtually or in person. Mr Hunt will discuss your history, review photographs, confirm the diagnosis, and explain all relevant treatment options. An in-person consultation also includes a hands-on chest wall examination, a pressure gauge measurement to assess flexibility, and a 3D scan for brace manufacture. If the initial consultation is virtual, a separate in-person assessment appointment is arranged before the brace is ordered.

The fitting appointment at Spire St Anthony's Hospital, Cheam takes around 45 minutes. Mr Hunt performs the preparatory manipulation where appropriate, fits the custom brace, and checks position and comfort. The brace is then worn continuously and without interruption — including overnight — until the follow-up check the next day, which typically takes 15–30 minutes. Fit is confirmed, any adjustments are made, and the personalised wearing schedule begins. The wearing schedule begins the day after the follow-up check, from which point daily removal for showering and sport is permitted as set out in the schedule.

Most patients describe it as uncomfortable rather than painful. A warming cream and topical anaesthetic are applied beforehand. The procedure takes around 15–20 minutes and involves focused, controlled pressure on the cartilage joints of the chest wall. Most patients tolerate it well. Simple painkillers such as ibuprofen are usually sufficient for the first few days afterwards.

Loose, comfortable clothing. It is helpful to come with a family member or friend, particularly for younger patients. Most patients are comfortable travelling home by public transport or car after the appointment.

Wearing the brace is uncomfortable rather than painful, particularly in the first day or two when the chest is still adjusting and the manipulation site may be a little tender. An over-the-counter painkiller such as ibuprofen or paracetamol is helpful in the first couple of days if needed. The experience is similar to wearing dental braces — initially noticeable and occasionally uncomfortable, but most patients have largely adapted to wearing the brace by the end of the first week.

The wearing schedule is tailored to each patient and provided in full at the follow-up check the day after fitting. In general, the brace is worn throughout the day and night, with two daily allowances built in from the start: around 20 minutes for bathing or showering, and 1–2 hours for sport or physical activity. The programme typically runs for 9–18 months depending on age, flexibility, and how quickly the chest corrects.

Yes — for most sports. A daily allowance of 1–2 hours for physical activity is built into the schedule from the start. The brace allows full arm movement and can be worn for most training. For contact sports such as rugby, judo, or martial arts, the brace should be removed during play. Please discuss specific sporting commitments with Mr Hunt at consultation.

The standard brace is not designed for prolonged immersion in water and should not be worn for swimming. After the initial weeks, short periods off the brace can be used for swimming. For competitive or frequent swimmers, the wearing schedule can be adapted.

The brace has a low profile and is custom-fitted to each patient. It is generally not noticeable under a loose-fitting top, jumper, or jacket. It will be more visible under a thin, close-fitting T-shirt. Most patients adapt quickly and find it manageable. The brace is considerably less conspicuous than the deformity it is treating.

Pressure and friction at contact points is the most common issue, particularly in the first few weeks. Check the skin regularly, keep it clean and dry, and apply a simple emollient such as E45 daily. Sudocrem helps with mild redness. If skin begins to break down, loosen the brace, apply a protective dressing, and email a photograph to the clinic for advice. Written skin care guidance is provided at fitting.

Occasionally — particularly in younger patients with very flexible chests, or where the brace is over-tightened. The chest may appear to dip inward temporarily. This is not dangerous and resolves with simple brace adjustment. If you notice it, email a photograph to the clinic for prompt advice. Overcorrection invariably settles once brace tension is reduced.

Reviews are scheduled at approximately 12 weeks, 26 weeks, and 42 weeks after fitting. The 12-week review can usually be done virtually if there are no concerns. Additional appointments can be arranged as needed, and email and telephone support is available throughout the programme with no limit on contact during the treatment period.

If bracing is not appropriate — or has not achieved the desired result — surgical correction can be discussed. Options for pectus carinatum include the modified Ravitch procedure and the minimally invasive hybrid approach. Mr Hunt will give an honest view of likely benefit for each option. The aim is always to recommend the most appropriate treatment for the individual, not to default to surgery where non-surgical management has a realistic chance of success.