Bracing for Success: Long-term Patient-reported Outcomes of Bracing Therapy for Pectus Carinatum

Pectus carinatum (PC) is typically managed by compressive bracing therapy during adolescence. This study assesses the long-term patient-reported outcomes of bracing therapy on adolescents diagnosed with PC.

We identified 867 patients diagnosed with PC and treated at our institution between 2013 and 2023. Patients and/or guardians were contacted via email and phone to complete a survey. The 17-question survey evaluated self-reported brace usage, cosmetic satisfaction, and quality of life outcomes.

Ninety-eight patients completed the survey; 81.6% were male, and 65.3% identified as not Hispanic or Latino. The mean age at initial clinic visit was 12.5 y (SD = 3.5). Bracing therapy was recommended for 70 (71.4%) respondents, and 51 (72.9%) proceeded with bracing therapy. Among those who underwent bracing, 7 (13.7%) patients had scoliosis and 6 (11.8%) had connective tissue disorders, including Marfan syndrome (n = 2), Ehlers-Danlos syndrome (n = 2), and kyphosis (n = 2). The mean daily wear time was 8.7 h (SD = 3.37), worn on average 6.39 d per week (SD = 1.24). Thirty-five patients (71.4% of 49 respondents) reported improvement in their chest wall appearance following bracing therapy. These patients braced for a significantly longer duration (mean = 25.2 mo, SD = 22.5) than those that saw no improvement in their chest wall appearance (mean = 10.2 mo, SD = 8.0; t = 3.28, P = 0.002). Twelve (23% of 42 respondents) patients reported a return of their PC after ending bracing therapy. Neither the number of hours worn per day nor the number of days worn per week was a statistically significant predictor of patient-reported improvement. Complications or negative effects during bracing were reported by 16 (31.4%) patients, including discomfort (n = 7, 44%), pain (n = 4, 25.0%), bruising/scarring (n = 3, 18.8%), irritation of gastrostomy tube site (n = 1, 6.2%), and poor self-esteem when bracing (n = 1, 6.2%).

Bracing therapy remains an effective treatment option for patients with PC. Overall, 23% reported their deformity returned after discontinuing bracing, and nearly one-third of patients reported negative effects from bracing therapy. Patients who reported an improvement in PC continued bracing treatment for a longer duration. Further studies need to be conducted to improve prolonged compliance and mitigate quality-of-life impacts in adolescents undergoing bracing therapy for PC.