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Surgery or non-operative treatment?

A first choice treatment is bracing. Only in patients with horseshoe deformity the only option is surgery. A limited experience with orthotics in  very young children seems promising. 

When should the deformity be assessed for the first time?

As early as possible.There is then enough time for parental counseling and  implementing adequate strategy. First individualised physiotherapy programme with calculated timing of external bracing to follow.

Which tests are required?

Basically no examinations are needed . A CAT scan may be helpful in selected patients.

When to brace?

The age of 8 years  appears suitable but compliance to bracing may pose a problem at this age.  This is why the best age seems adolescence well before the age of 19 yrs when the chest becomes less flexible.

May a suction cup be helpful?

Not in pectus carinatum.

What is the duration of treatment?

It usually takes 6 months to radically improve the deformity but may last a few months longer.

Is surgery an option in pectus carinatum?

In the majority of patients orthotics seems the best option with the exception for horseshoe defects.

What are the results of nonoperative treatment?

In over 90% of the patients the results are excellent.

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