Determinants of Successful Pectus Carinatum Bracing: A Narrative Review

Pectus carinatum (PC) is a chest wall deformity characterized by the anterior projection of the sternum that typically manifests in adolescence and may result in notable psychosocial morbidity despite insubstantial physiological signs. Historically considered less common than pectus excavatum, recent trends suggest that PC may be underdiagnosed, with increasing recognition and referrals to specialized pectus clinics. The main objective of this review is to provide a comprehensive understanding of the role of bracing, particularly the dynamic compression system, in the non-surgical management of PC. Traditionally, a surgical condition, PC is currently being treated more often with dynamic compression bracing, especially in younger, more flexible chest wall patients. This evidence-based review aims to analyze the optimal time to start bracing, using current literature on anatomical correction, compliance, and psychosocial outcomes. It is known that early treatment, ideally at the pre-pubertal or early pubertal stage, can result in better-bracing success, shorter treatment time, and more favorable cosmetic and emotional outcomes. The key determinants of treatment effectiveness are age, severity of deformity at the start of treatment, pressure limits, brace type, and patient cooperation. Further, physiotherapy and psychosocial support have been found to have a positive impact on adherence and quality of life. However, there is no standard protocol for bracing. As outlined in this review, the proposed solution is a patient-centered, multidisciplinary approach that combines clinical timing and personalized care to develop feasible guidelines for effective and timely bracing in adolescents with pectus carinatum.