Does Pectus Carinatum Come Back After Removing the Brace? Two Situations, Completely Different Approaches

Introduction

After wearing a Pectus Carinatum brace for many months, the day finally comes when it can be removed. But a few months later, many parents notice that the sternum is starting to protrude again. Is it a problem with the brace, or was the deformity never truly corrected?

This situation occurs repeatedly in Pectus Carinatum parent groups. Many people think that removing the brace means the correction is finished. In reality, removal is just a milestone – stable‑phase management afterward is equally important.

Relapse after pectus carinatum correction generally falls into two situations that are completely different in nature, and the approaches to dealing with them are also entirely different. Understanding which situation you are facing is the key to effective management.

Situation A: Treatment Not Completed – Stopped Too Early

This is the most common scenario.

The essence of non‑surgical correction of pectus carinatum is to use continuous external force to gradually reshape the sternum and costal cartilages. It takes a sufficiently long period of sustained pressure for the cartilages to go from passive moulding to a relatively stable shape.

If correction is stopped before the cartilages have been fully remodelled and the shape stabilised, the elastic recoil of the cartilages will push the sternum outward again once the external force is removed. This is not truly a “relapse”; it is interruption of the correction process before completion.

In clinical observation, this situation often occurs at the following points:

• The chest appears flat to the naked eye, and parents decide on their own to stop

• The child resists wearing the brace, gradually reducing wear time until stopping completely

• Long interruptions due to hot weather, the school term, etc., with no resumption

A study in the Chinese Journal of Pediatric Surgery points out that the effectiveness of non‑surgical correction of pectus carinatum is closely related to the total duration of brace wear, and stopping too early is a major reason why correction results are not maintained [1].

How to Tell When Treatment Is Truly Completed?

Removal of the brace should not be decided by parents based on appearance alone. Instead, a specialist evaluation should consider several dimensions:

• Imaging studies – to confirm whether the shape of the sternum and costal cartilages has reached the expected improvement

• Cartilage elasticity assessment – to determine whether the cartilages have entered a relatively stable state

• Growth and development stage – whether the skeleton is still in a rapid growth phase, and whether a maintenance phase is needed

Generally, a tapered wearing period (maintenance phase) is required after active correction, allowing the shape to stabilise gradually without the brace, rather than stopping abruptly.

Situation B: Treatment Completed, but Protrusion Returns After 1–2 Years

This situation is less common but deserves more attention.

If the brace has been worn according to the full prescribed course, a specialist evaluation has confirmed stable shape, but then the sternum noticeably protrudes again within 1–2 years after stopping, this is a true relapse. There is usually one or more unresolved underlying causes that continue to act.

Cause 1: Shape “Catch‑Up” During Rapid Skeletal Growth

Some children enter a rapid growth phase (puberty) shortly after finishing brace treatment. If the child was still in an active growth period when correction ended, newly grown cartilage may continue to develop in the original abnormal pattern, causing the sternum to protrude again.

Approach: Re‑evaluate whether supplementary correction is needed before the growth peak ends, or extend the maintenance phase.

Cause 2: Posture and Core Muscle Strength Not Simultaneously Improved

Pectus carinatum is not just a bone shape problem. Many patients also have thoracic hyperkyphosis (rounded back), scapular protraction, and weakness of deep core muscles.

If only the bone shape was corrected without improving posture and muscle strength, after the external force is removed, poor posture and muscle imbalance will continue to influence the chest wall, pushing the sternum outward again.

European paediatric surgery research suggests that pectus carinatum correction should be combined with postural training and respiratory muscle strengthening; ignoring posture compromises long‑term stability [2].

Cause 3: Underlying Connective Tissue Problems

Pectus carinatum is a common feature of connective tissue disorders such as Marfan syndrome. Such conditions affect the elasticity and stability of cartilage and connective tissue, making it difficult to maintain correction over time.

Consider screening for connective tissue issues if the child has:

• Tall, slender build with long limbs

• Joint hypermobility

• Family history of connective tissue disorders

• Unstable or fluctuating results during brace treatment

A study in Pediatric Surgery International notes that patients with pectus carinatum and connective tissue involvement require a longer correction period and stricter maintenance‑phase management [3].

Comparison of Approaches for the Two Situations

Frequently Asked Questions (FAQ)

Q1: How long after removing the brace is the shape considered stable?

A: There is no uniform standard. It is generally considered that if the shape shows no significant change during a 6–12 month maintenance period after the end of the growth peak, it is relatively stable. Each child’s growth rhythm is different, so regular follow‑ups are recommended.

Q2: If the sternum seems slightly prominent right after removing the brace, should we put it back on immediately?

A: Mild rebound shortly after removal is normal – the cartilages need time to adapt to the absence of external force. Observe for 2–4 weeks; if the protrusion continues to increase, contact a specialist for evaluation.

Q3: If relapse has already occurred, can we restart correction?

A: In most cases, yes – especially if the child is still in an active growth phase and the cartilage retains good elasticity. Before restarting, try to identify the cause of relapse and adjust the plan accordingly.

Summary

Recurrence of sternal protrusion after removing a Pectus Carinatum Brace falls into two distinct situations:

• Situation A: Treatment not completed – stopped too early → the core need is to resume proper wear.

• Situation B: Treatment completed, but underlying causes were not addressed → requires systematic investigation and a targeted adjustment of the treatment plan.

In either situation, it is not advisable for parents to make decisions on their own. Consulting a specialist for evaluation is a safer approach.

Disclaimer: This article is for general health information only and does not constitute medical advice or a treatment plan. If you have concerns, please consult a qualified physician.

Guangzhou Yikang Medical Technology Co., Ltd. focuses on the development and promotion of non‑surgical treatment solutions for chest wall deformities (Pectus Excavatum and pectus carinatum). For product information, visit our official website: https://www.emkmed.com

References

[1] Liu WY, Wang G. Advances in non‑surgical correction of pectus carinatum[J]. Chinese Journal of Pediatric Surgery, 2015, 36(8): 612-615.

[2] Haecker FM. The vacuum bell for conservative treatment of pectus carinatum: a single institution experience[J]. Pediatric Surgery International, 2011, 27(6): 623-627.

[3] Brochhausen C, Turial S, Müller FK, et al. Pectus Excavatum: history, hypotheses and treatment options[J]. Interactive CardioVascular and Thoracic Surgery, 2012, 14(6): 801-806.