Spine & Chest

    Pectus Carinatum in Adolescents: Compressive Brace or Surgery?

    Protruding sternum: pectus carinatum is assessed for flexibility and progression; a compressive brace can help flexible forms, while rigid or severe forms are referred to a thoracic surgeon.

    Medically reviewed: August 2026·Dott. Daniele Priano

    Quick Answers

    Does pectus carinatum get worse with age?
    Pectus carinatum may become more prominent during the pubertal growth spurt, when costal cartilage growth is maximal. After skeletal maturity the deformity tends to stabilize. Addressing the pathway during adolescence, when the chest wall is still remodelable, may offer more options compared to adulthood.
    When is a compressive brace useful?
    The compressive brace is considered in flexible forms, in patients still growing. The rationale is to apply gradual and prolonged pressure on the protruding area. Effectiveness depends greatly on deformity flexibility and adherence to the protocol, to be agreed case by case.
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    Pectus Carinatum in Adolescents: Compressive Brace or Surgery? - Pediatric Orthopaedics Milan Dr. Priano

    Pectus carinatum — commonly called pigeon chest, and described by families as a protruding sternum or protruding ribs — is an anterior protrusion of the sternum and/or costal cartilages caused by overgrowth of the chondrosternal cartilages. It is less common than pectus excavatum, predominantly affects males, and typically appears or worsens during the pubertal growth spurt (around 11-15 years). The visit assesses morphology, manual flexibility of the deformity, and psychosocial impact on the adolescent; advanced imaging is reserved for selected or pre-surgical cases. Care is built case by case: in flexible forms in growing patients a dynamic compressive brace may be considered as a specialist option, while rigid or resistant forms are referred to a dedicated paediatric thoracic surgery team for evaluation. Choices depend on flexibility of the deformity, age, the adolescent's experience, and the family's priorities.

    Assessment and treatment

    When to seek evaluation

    • Visible protrusion of the chest wall
    • Psychological discomfort related to appearance
    • Worsening during pubertal growth
    • Request for evaluation of treatment options

    What is evaluated

    • History and adolescent's experience
    • Clinical assessment of the chest wall
    • Manual flexibility testing under pressure
    • Advanced imaging only in selected or pre-surgical cases
    • Cardiac and respiratory evaluation when clinically indicated

    Treatment options

    • Observation and reassurance in mild forms
    • Dynamic compressive brace in flexible deformities in growing patients
    • Trunk muscle strengthening exercises
    • Referral to a paediatric thoracic surgery team for rigid or resistant forms

    Frequently Asked Questions

    Does pectus carinatum get worse with age?▼
    Pectus carinatum may become more prominent during the pubertal growth spurt, when costal cartilage growth is maximal. After skeletal maturity the deformity tends to stabilize. Addressing the pathway during adolescence, when the chest wall is still remodelable, may offer more options compared to adulthood.
    When is a compressive brace useful?▼
    The compressive brace is considered in flexible forms, in patients still growing. The rationale is to apply gradual and prolonged pressure on the protruding area. Effectiveness depends greatly on deformity flexibility and adherence to the protocol, to be agreed case by case.
    Does pectus carinatum cause respiratory or cardiac problems?▼
    In most cases pectus carinatum is an **aesthetic and psychosocial** issue, not a functional one. Unlike pectus excavatum, it rarely compresses heart or lungs. The main reason families seek evaluation is the discomfort experienced by the adolescent, especially in contexts where the chest is exposed.
    Can sports be played with pectus carinatum?▼
    Yes, sport is encouraged. Activities that strengthen trunk musculature (swimming, postural exercises, back work) can improve posture and overall appearance. There are no absolutely contraindicated sports. Even during a possible pathway with a brace, physical activity generally remains possible, according to case-specific indications.
    When is surgery considered?▼
    Surgery is considered in rigid cases that do not respond to bracing or in patients reaching evaluation after the end of growth. In these cases the pathway is a referral to a dedicated paediatric thoracic surgery team, who will discuss available techniques (from more traditional ones such as modified Ravitch to minimally invasive ones such as Abramson). Indication is always shared multidisciplinarily and openly discussed with the teenager and family.
    How is pectus carinatum treated?▼
    Treatment is chosen according to the flexibility of the deformity and the patient's age. Mild forms may only require observation and reassurance; flexible forms in patients still growing are assessed for a **dynamic compressive brace**, often combined with trunk strengthening and postural work; rigid forms, or those resistant to bracing, are discussed as surgical candidates. There is no single protocol: the pathway is built together with the adolescent and the family after the visit.
    What are the symptoms of pectus carinatum?▼
    In most cases the only sign is visual: the sternum and costal cartilages protrude forward, giving the chest a 'keel' shape. Some adolescents report tenderness on pressure over the protruding area or discomfort when lying prone. Respiratory or cardiac symptoms are rare, unlike in pectus excavatum. The most frequently reported burden is psychosocial.
    Can pectus carinatum be corrected without surgery?▼
    In flexible forms in a patient still growing, correction without surgery is a realistic goal, typically with a compressive brace worn according to the agreed protocol. There are no exercises, supplements or 'natural' remedies that can correct the deformity on their own: muscle and postural work is a useful complement, not a substitute for bracing. After skeletal maturity the chest wall is less remodelable and non-surgical options are reduced.
    Is pectus carinatum different in adults and in girls?▼
    The deformity is more common in males, but it can also affect girls, where the protruding sternum is often noticed differently because of chest conformation. In adults, once growth is complete, the chest wall is rigid: the compressive brace loses effectiveness and, when the impact is significant, evaluation shifts toward the surgical option, with referral to a chest wall specialist or surgeon with expertise in adult patients. This is why assessment during adolescence generally offers more options.

    Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.