Contemporary treatment of pectus carinatum in children and adolescents

Pectus carinatum, a congenital chest deformity affecting 0.3–0.7% of the population (mostly males), has traditionally been treated surgically, particularly via the Ravitch procedure. However, dynamic compression bracing (DCS) has emerged as a non-invasive, safer, and cost-effective alternative, especially for young patients with flexible chest walls. By measuring initial correction pressure (PIC), clinicians can tailor treatment more effectively. Patients with lower PIC (<10 psi) respond particularly well, achieving correction rates of 80–90%.
Between 2013 and 2016, 286 patients began DCS-bracing, with a 91% male population and average age of 14. Among them, 78 completed treatment with a mean duration of 14 months. A larger cohort (2013–2020) showed an 85% success rate out of 740 patients. Factors such as higher carinatum height and PIC were linked to longer treatment and more symptoms. Recurrence was low (1.5%).
A literature review (1,185 patients) confirmed DCS-bracing as effective and safe, with a 2.6% recurrence rate and rare complications. Comparative analysis showed that although Ravitch surgery had a slightly higher success rate (92.4%), it also had more complications (32.4%). Motivation and compliance were key predictors of success in bracing.
Psychological studies revealed that DCS-bracing significantly improved quality of life, appearance satisfaction, and reduced distress, particularly within the first year. Inter-observer assessments showed variation in rating deformity severity and outcomes, supporting the need for objective evaluation tools.
Overall, DCS-bracing is recommended as the first-line treatment for most pectus carinatum patients, reserving surgery for severe or unresponsive cases.