From the Research
The management of pectus carinatum should primarily involve dynamic compression bracing as the first-line treatment, given its noninvasiveness, good results, and lower complication rate compared to surgery, as supported by the most recent and highest quality study 1.
Key Considerations
- Compression bracing is most effective in patients with flexible chest walls and should be worn for 8-23 hours daily for 3-12 months, with gradual reduction as improvement occurs.
- Compliance is crucial for success, with reported correction rates of 60-80% 1.
- Surgical correction, such as the modified Ravitch procedure or minimally invasive approaches, is reserved for severe cases or when bracing fails.
- Treatment timing is optimal during puberty when the chest wall remains malleable, though adults can still benefit from intervention.
- Psychological support is important as the condition can affect body image and self-esteem.
Treatment Approach
- For mild cases, observation is appropriate as some deformities may improve spontaneously, especially during adolescence.
- Compression bracing is the first-line treatment for moderate cases, particularly in patients with flexible chest walls.
- The dynamic compression brace should be worn for 8-23 hours daily for 3-12 months, with gradual reduction as improvement occurs.
- Physical therapy can complement treatment by improving posture and chest wall flexibility.
Important Factors
- Motivation and compliance are important factors influencing outcomes, and patients with a higher pressure of initial compression (>8.0-8.5 psi) and Marfan syndrome or Poland syndrome have poorer outcomes 1.
- In such patients, surgery may be considered as an alternative treatment option.
- The underlying cause of pectus carinatum is abnormal growth of costal cartilage, creating anterior chest wall protrusion, which explains why interventions targeting cartilage remodeling are effective.