Pectus excavatum vs pectus carinatum: the differences
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: they are opposite chest wall deformities. In pectus excavatum the breastbone sinks in; in pectus carinatum, or pigeon chest, it sticks out. Excavatum usually shows in the first year of life and carinatum in the teenage years. Non-surgical treatment is opposite too: a vacuum bell that pulls outward for one, a brace that presses inward for the other.
The differences at a glance
| Pectus excavatum | Pectus carinatum | |
|---|---|---|
| What happens | The breastbone sinks in | The breastbone or ribs stick out |
| Other names | Sunken chest, funnel chest | Pigeon chest |
| How common | 1 in 300 to 1 in 1,000 births | About 1 in 1,000 teenagers |
| Sex | About 5 times more common in males | Nearly 4 times more common in males |
| When it shows | In the first year of life in most cases; more pronounced at puberty | From age 10, peaking at 16 in girls and 18 in boys |
| Family history | 35-40% | 25-33% |
| Symptoms | There may be none; when present, shortness of breath, chest pain and palpitations | Often none; sometimes tenderness over the area, shortness of breath and less endurance |
| Non-surgical treatment | Vacuum bell, in selected cases | Compression brace |
| Surgery | Nuss and Ravitch procedures | Modified Nuss; Ravitch is now rarely used |
What types of pectus carinatum are there?
- Chondrogladiolar: the most common. The body of the breastbone sticks out.
- Chondromanubrial: the upper part of the breastbone sticks out. It is less flexible and causes breathing symptoms more often.
How is pectus carinatum treated?
The usual treatment for someone who is still growing is a brace that presses on the protruding area. It is worn for 14 to 24 hours a day, over or under clothing. It works best before the growth spurt and becomes less effective after age 19.
A recent example: in a series of 140 children and teenagers aged 6 to 22 who wore a custom-made brace for at least 23 hours a day over two years, the deformity resolved completely in 34.8%, and the authors report improvement in all of them. It is a preliminary, single-center study.
When surgery is needed, surgeons use a variant of the Nuss procedure, with a bar left in for about two years.
Can you have both at once?
Yes. There is a rare mixed form that combines a sunken area with a protruding one. In a series of 283 patients with pectus excavatum it accounted for 1%.
What do they have in common?
- Both are more common in males and become more visible with growth.
- Both are associated with Marfan syndrome and scoliosis.
- Both affect body image. In a study of 71 people with pectus excavatum, 19 with pectus carinatum and 82 with no deformity, body image in both patient groups was highly disturbed compared with the control group. We cover this in body image and confidence.
Does this site apply to pectus carinatum?
Pectus Academy is about pectus excavatum. The vacuum bell pulls the breastbone outward, so it makes no sense on a chest that already sticks out. If you have pectus carinatum, your doctor is the person to see: the brace is prescribed and adjusted at the clinic.
What we know and what we don't
What we know
- They are opposite deformities with opposite conservative treatments.
- Bracing works best in people who are still growing.
What we don't know
- The exact cause of either one.
- We have not reviewed the bracing evidence in depth: this page only covers the essentials.
Keep reading
- What is pectus excavatum?
- Vacuum bell: how it works and what the evidence says
- Can you fix pectus excavatum without surgery?
This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.
Sources
- Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
- Mayo Clinic. Pectus excavatum: diagnosis and treatment, updated March 14, 2025. mayoclinic.org
- McHam B, Winkler L. Pectus Carinatum. StatPearls, updated July 31, 2023. ncbi.nlm.nih.gov/books/NBK541121
- Frediani S, Zarfati A, Pardi V, et al. A new custom-made bivalve brace for pectus carinatum in children and adolescents: preliminary promising experience of 140 patients from a tertiary center. Frontiers in Pediatrics, 2024;12:1321633. doi.org/10.3389/fped.2024.1321633
- Kelly RE Jr, Quinn A, Varela P, Redlinger RE, Nuss D. Dysmorphology of Chest Wall Deformities: Frequency Distribution of Subtypes of Typical Pectus Excavatum and Rare Subtypes. Archivos de Bronconeumología, 2013;49:196-200. archbronconeumol.org
- Steinmann C, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image. European Journal of Cardio-Thoracic Surgery, 2011;40(5):1138-1145.
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