“My Daughter Won’t Get Pectus Carinatum – That’s a Boy’s Disease” – How This Misconception May Be Delaying Diagnosis in Girls

1. “Isn’t Pectus Carinatum Only a Boy’s Disease?”

In many parents’ minds, Pectus Carinatum is considered a “boy’s disease.” Epidemiological data indeed show a male‑to‑female ratio of approximately 4:1 to 5:1 [1][2]. A 2025 study from Southampton General Hospital (UK) included 430 children with pectus carinatum – 364 boys and only 66 girls [1].

Thus, when a girl presents with sternal protrusion, parents often react:

“It can’t be pectus carinatum, right?”
“It’s probably just a postural problem.”
“It will go away after she finishes growing.”

However, the same study revealed a long‑overlooked fact: pectus carinatum in girls differs systematically from that in boys, and these differences may lead to diagnostic delays [1].

2. Three Distinctive Features of Pectus Carinatum in Girls

Bough et al. conducted a systematic review of 430 children with pectus carinatum treated between 1998 and 2022 and identified several noteworthy gender differences [1].

① Earlier Age at Detection

The median age at first observation was 10 years for girls versus 14 years for boys (p = 0.003).

• A 10‑year‑old girl is in early puberty. Parents and primary care physicians are more likely to attribute mild sternal protrusion to being “thin” or having “poor posture” rather than to a structural deformity.

• By age 14, boys are in their growth spurt, and sternal protrusion becomes obvious, making it easier to recognise.

② Higher Proportion of Chest Wall Pain as a Presenting Symptom

Nearly half of the girls with pectus carinatum reported chest wall pain (44%) , compared with only 26% of boys (p = 0.041) [1].

However, “chest pain in girls” is often first referred to breast clinics, cardiology, or dismissed as “growing pain,” rather than being evaluated by a chest wall deformity specialist.

③ Stronger Familial Clustering

Among girls with pectus carinatum, 33% had a family history of chest wall deformities, versus 20% in boys (trend‑level difference) [1].

This means: if the affected child in a family is a girl, the risk of chest wall deformity in a second child may be higher.

3. Why Are Girls More Likely to Be Missed or Delayed?

Based on current evidence, three main reasons stand out:

1. Cognitive Anchoring Bias

When a disease is labelled as a “boy’s disease,” doctors and parents unconsciously lower their vigilance when a girl presents with suggestive symptoms. The “4:1 male‑to‑female ratio” in the APSA guideline describes the treated population, but Bough et al. suggest that the true prevalence of pectus carinatum in girls may be underestimated [1].

2. Concealment by Breast Development

Pubertal breast development can “hide” mild‑to‑moderate sternal protrusion. Many girls only notice the abnormality when wearing a swimsuit or tight clothing after breast development is complete – by then, the ideal window for brace therapy may have been missed.

3. Psychological Shame

A 2024 French study by Mauduit et al. found that even among diagnosed children with pectus carinatum, a considerable proportion feel uncomfortable wearing a brace in front of others [3]. Girls have stronger self‑consciousness about their chest appearance in situations such as locker rooms and PE class, which may lead them to actively avoid seeking medical care.

A 2026 review also notes that the degree of impairment in body image satisfaction and social confidence in children with pectus carinatum is comparable to that in children with Pectus Excavatum [4].

4. Brace Therapy: Equally Effective in Girls

The Pectus Carinatum Brace is the first‑line conservative treatment for mild‑to‑moderate cases [2].

A 2026 study by Hong et al. published in Pediatric Surgery International included 208 children and compared a low‑intensity regimen (8–12 hours/day) with a high‑intensity regimen (>16 hours/day) [5]:

For girls, the low‑intensity regimen (worn at home during evenings or overnight) has a clear psychological advantage: it does not require wearing the brace at school, does not interfere with PE classes or social activities.

Mauduit et al. also found that 82.1% of patients believed improving brace comfort was key to enhancing compliance [3].

Several Pectus Carinatum Braces are available on the market. Products like the EMK Yikang Pectus Carinatum Brace are designed with adjustable pressure control systems and ergonomic curvature to fit the chest wall, essentially aiming to lower both the “psychological barrier” and “physical barrier” to wearing, helping children stay on track.

5. Advice for Parents

1. Take Sternal Protrusion in Girls Seriously

Do not delay evaluation because “pectus carinatum is a boy’s disease.” If a girl around age 10 develops sternal protrusion, especially if accompanied by chest wall pain (44%) or family history (33%) [1], consult a thoracic surgeon or paediatric surgeon promptly.

2. Focus on Psychological Impact, Not Just Appearance

Studies show that children with pectus carinatum can be significantly affected in terms of social avoidance and sports participation [3][4]. For girls, these effects may be exacerbated after breast development.

3. “Consistency” Matters More Than “Intensity”

A low‑intensity regimen of 8–12 hours/day achieves comparable success rates to a high‑intensity regimen, with better compliance and satisfaction [5]. Choosing a comfortable, low‑profile brace product is an important factor in maintaining long‑term adherence.

References

[1] Bough GM, et al. Epidemiology, presentation and aspirations in Pectus carinatum: a retrospective cohort study. Pediatr Surg Int. 2025;42(1):56. DOI: 10.1007/s00383-025-06206-4 | Retrospective cohort study (n=430)

[2] APSA Pediatric Surgery NaT Review. Pectus Carinatum Guideline. 2020. | Professional society clinical guideline

[3] Mauduit M, et al. Bi-valve braces for treatment of pectus carinatum in teenagers. Cardiothorac Surg. 2024;32:14. DOI: 10.1186/s43057-024-00132-2 | Quality‑of‑life study (n=28)

[4] Toselli S, et al. Psychological Impact of Congenital Chest Wall Deformities. Children. 2026;13(2):237. DOI: 10.3390/children13020237 | Review of psychosocial impact

[5] Hong SM, et al. Orthotic bracing for children with pectus carinatum: low-intensity versus high-intensity regimens. Pediatr Surg Int. 2026;42:193. DOI: 10.1007/s00383-026-06416-4 | Clinical study (n=208)

Disclaimer: This article is based on publicly available peer‑reviewed medical literature and is for general health information only. It does not constitute individual medical advice. If you have concerns, please consult a qualified physician.

EMK Yikang Medical 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