Purpose <p>Adolescent idiopathic scoliosis (AIS) is commonly associated with rib hump (RH) deformity, which poses a significant cosmetic concern for patients. Traditionally, thoracoplasty (TH) has been the preferred treatment to address this issue. This systematic review and meta-analysis evaluates the impact of combining TH with posterior spinal fusion (PSF) compared to PSF alone in AIS surgery. It focuses on patient-reported outcome measures (PROMs), particularly self-image scores, to assess the true cosmetic benefit of incorporating TH into PSF procedures.</p> Methods <p>Following PRISMA guidelines, a systematic review was conducted from inception to March 2025 using Medline, Scopus, Embase, and Cochrane Library. Search terms included “thoracoplasty”, “scoliosis”, “rib hump”, “Scoliosis Research Society Score” and “self-image scores”. Outcomes assessed included surgical and radiological metrics, functional outcomes and complications. A meta-analysis was conducted to compare PROMs between patients treated with TH + PSF and those treated with PSF alone. The risk of bias was assessed using the MINORS score.</p> Results <p>The 5 included studies had a level of evidence of either 2 or 3, with a total of 599 patients analyzed. Patients who underwent TH + PSF (n = 270) did not exhibit statistically significant differences in functional outcomes, including SRS questionnaire scores for pain, function, mental health, satisfaction, self-image, and overall score, compared to those who underwent PSF alone (n = 329) (p &gt; 0.05). Additionally, the TH + PSF groups experienced an higher rate of postoperative complications compared to the PSF alone groups.</p> Conclusion <p>The current meta-analysis indicates that TH did not result in significant improvements across any PROMs domains when added to PSF in AIS patients. Further well-conducted randomized controlled trials are needed to refine clinical decision-making by identifying the degree of deformity that may benefit from the addition of TH.</p>