About Vacuum Bell Therapy for Pectus Excavatum

The Vacuum Bell is a simple, non-invasive tool used for the non-surgical treatment of Pectus Excavatum. It consists of a silicone bowl with an attached hand pump, that when used, creates a mild suction over the chest.

There have been multiple clinical studies done using the Device with Pectus Excavatum since 2007. These have all reported high success rates across different patient groups, with minimal to no side effects. A recent 2025 clinical study on paediatric Vacuum Bell Therapy from Amsterdam reported a 50% complete correction rate among 165 patients, with a treatment length of 12-24 months.

The study notes that, "of all patients finishing treatment, 52.1% finished treatment successfully (with a permanent correction of the Pectus deformity). Factors contributing to a successful treatment included longer daily hours of Vacuum Bell Therapy, overnight use, and a prolonged treatment duration (12+months).

A flexible thorax, a deeper deformity, and symptomatic Pectus were associated with worse outcomes. Sternal depression was evaluated as mild/light in 44.2% of all patients treated successfully, compared to 26.6% in the unsuccessfully treated patients. Complications during treatment were minor, and there were no long-term complications."

Anyone seeking a non-invasive alternative to surgery for Pectus Excavatum is a possible candidate for the Treatment; however, age and depth of severity are useful in determining which patients are most likely to have better outcomes. According to Dr Frank-Martin Haecker, a major pioneer in the field of Vacuum Bell Therapy for Pectus Excavatum, Vacuum Bell treatment is suitable for all ages.

"In general, Vacuum Bell Therapy is feasible at nearly any age. Patient's age and patient's compliance, as well as the ventral surface for local application, are important factors. We believe that Vacuum Bell Therapy is indicated in patients who present with mild Pectus Excavatum and/or wish to avoid a surgical procedure".

In summary, the two main selection criteria for ideal candidates are age and depth severity.

For age, patients aged 6-18 have been observed to have better permanent outcomes with the treatment, due to growth factors and the chest wall's flexibility. Therefore, it's best to start treatment as early as possible, even at 7 years of age, before the indent worsens during the pubertal growth spurt. Breast development is also a problem for female patients starting puberty, and thus, pre-adolescence is an ideal time to start Vacuum Bell Treatment.

Depth severity is not a major problem in under-18 patients, and full correction is often still observed in even moderate depths, albeit at a slightly lower rate. In older patients, depths over 1.5cm are usually better suited to surgical treatments like the Nuss Procedure. Nevertheless, the Vacuum Bell can still provide adequate results in these patients who wish to avoid surgery.

Another factor to be aware of in older patients is that the chest wall is often stiffer and requires greater vacuum pressure to move effectively. After some time using the Device (usually at least 4 weeks), the chest wall will gradually soften and require less pressure to move the chest. This has been proven in clinical studies by doctors utilizing pressure gauges to measure the effective vacuum needed at different stages of the treatment.

Yes, exercises for Pectus Excavatum are recommended to enhance treatment outcomes and can even be done while wearing the device. Pectus Excavatum patients commonly present with secondary issues such as 'pot-belly', flared ribs, and hyperlordosis (anterior pelvic tilt). Exercise and stretching are effective ways to correct these conditions.

Furthermore, even after the first treatment session, patients may notice a significant improvement in their upper body posture. This is because the Pectus funnel can pull the upper body forward into kyphosis (forward slouching). To enhance this straightening process, it's recommended to incorporate posture correction exercises, such as foam rolling and stretching.

Vacuum Bell treatment should be avoided in patients with certain conditions, such as
skeletal diseases that affect the firmness of the bones, Osteogenesis
Imperfecta (glass bones) and Osteoporosis (diminution of the compact bone tissues).
Angiopathy, resulting from Marfan's syndrome or an Aneurysm. In cases of Coagulation Dysfunctions, including Thrombopathy or Haemophilia (bleeding disorders)

The recommended minimum length of treatment is 12 months for patients under 13, and 24 months for those above. This is based on multiple clinical trials with the Device for Pectus Excavatum since 2007. While results can usually be seen after the first few sessions, permanent outcomes have been well-studied with treatment lengths of 12-24 months.

The most common side-effects of Vacuum Bell treatment are skin bruising and irritation. These usually stop completely after continued use. Fluid accumulation underneath the skin can also occur when the pressure is too high. All of these side effects are temporary.

Dr Frank-Martin Haecker, a Pectus specialist who has treated hundreds of patients with the Vacuum Bell cites the following common side effects: "During the first five applications, most of the patients experienced moderate pain in the sternum and reported a feeling of pressure within the chest. Adolescents and older patients can develop moderate subcutaneous hematomas (bruising), which disappear within a few hours. Some patients report temporary side effects, including transient upper-extremity paresthesia during application and/or mild dorsalgia. These symptoms disappear when lower atmospheric pressure is used during application. Analgesic medication is usually unnecessary, and its usage was not reported by any patients or parents. As mentioned above, parents or caregivers should supervise children under 10 years old. In this age group, no relevant side effects were reported."

Other common side effects relate to the thoracic spine and posture. The upper back might crack during and after Vacuum Bell Therapy; this is normal and to be expected. When the sternum lifts, the spine can move back to its natural position and crack.

Consistent daily use is required to effectively treat Pectus Excavatum with the Vacuum Bell. A good medical-grade device is designed for comfort and allows easy daily use. Most users integrate the therapy into their daily routine, just as one does when brushing their teeth.

Posture improvements and relief from cardiopulmonary symptoms begin immediately once the sunken chest has lifted, and this is often achieved quickly, within days.

However, for permanent correction, the device needs to be worn consistently for 12-24 months. Patients should stick to a daily treatment protocol to achieve optimal results and reduce the risk of the chest sinking back in when treatment is finished.

No, the Vacuum Bell Device is not painful and is considered a minimally invasive treatment. Some users might experience a slight sensation of pressure the first time they use the device; however, this usually ceases after a few sessions.

Yes, according to a 2016 comprehensive meta-analysis of Vacuum Bell Therapy, the device shows excellent results with asymmetrical Pectus. Most studies conclude that patients with asymmetry can achieve the same results as those without, but note that some chest asymmetry is often still visible after correction.

Patients beginning Vacuum Bell Therapy should start with a gradual, slow approach. It's recommended to gradually lift the deformity over 4-6 weeks until it touches the glass on the Device. This method is recommended by some doctors and clinics because they believe it may lead to better treatment outcomes, although there are no scientific studies to support this. The idea is to maintain the firmness of the chest wall and prevent the chest from sinking back easily.

According to Eckart Klobe, the device's inventor, "A skilful treatment will be to lift the pectus indent slowly and gradually in order to minimise the temporary
loss of firmness in the ribcage. Even 2 or 4 weeks of treatment time before the funnel is finally lifted close to the viewing glass is normally well spent. Over the whole time of treatment, the patient should avoid unnecessarily strong vacuum or extreme variations in vacuum force."

Dr Frank Martin Haecker, in a highly cited study on the effectiveness of Vacuum Bell Treatment, recommends the following protocol for beginners: "After exclusion of cardiac anomalies and other contraindications, Pectus patients may start with the daily application. All users are recommended to use the Device twice daily for 30 minutes each for the first 4–6 weeks. Later on, the duration of daily Vacuum Bell application will vary widely between patients. Some adult patients use the Device for up to 8 hours daily during office hours, whereas adolescent boys may apply it every night for 7–8 hours. In our experience, the duration and frequency of daily application depend on each patient’s individual choice and motivation.

The authors of a 2025 Vacuum Bell Study with 259 patients recommend the following protocol: "Patients are instructed to begin using the Device two to three times per day for 30–60 min, gradually increasing the duration and the applied suction as tolerated. We recommend wearing the Vacuum Bell Device overnight and during routine activities, such as eating, homework, or gaming, to help accumulate the necessary wear time. However, it is important to note that overnight use should not begin in the first two to three months, since the skin has to adapt in order to endure the prolonged suction applied overnight. There is no standard treatment duration; if there is still progression and the patient remains motivated, we advise them to continue the Treatment. After the deformity is fully corrected, patients enter the retainer phase, i.e., the treatment phase in which wearing time is gradually reduced to maintain chest wall correction. Treatment is considered successful if patients, parents, and the surgeon regard the result as aesthetically pleasing, and therapy is stopped.

The Vacuum Bell size should be selected so that it's wide enough to cover the entire Pectus area. The middle of the device should be centred over the deepest point of the indent. Hair on the chest can interfere with the device's seal. If you notice a slow loss of suction, it might be necessary to shorten it by shaving. A correctly functioning Vacuum Bell shouldn't lose air when applied to hair-free skin.

Before applying the Vacuum Bell, it's essential to assume a neutral upper-body posture. Pectus naturally pulls the upper spine forward into kyphosis (slouched posture). Applying the Vacuum Bell in this position is not recommended and can generate poor results.

To get into a good posture, try positioning yourself at the end of a bed, so that your back is flat on the bed, and your pelvis sits off with the feet touching the floor. From this position, you can let your pelvis sink down and create an arch in the upper back whilst pushing the chest out. After getting in position begin applying suction.

Experiment with different positions when applying the Vacuum Bell and see what works best for you.

No, Vacuum Bell Therapy has been proven using medical imaging to physically move the sternum to a normal position, the same as would be achieved with surgery.

The misconception that the Vacuum Bell Device causes only cosmetic changes may have arisen from the myth that the chest wall is composed of bone.

While the surrounding ribs are made of hard bone, the tissue attached to the sternum on the front of the chest is soft cartilage and can be moved easily with the Vacuum Bell.

Moreover, patients who have undergone treatment often note an immediate improvement in cardiovascular symptoms associated with Pectus Excavatum.

Symptoms such as shortness of breath, heart palpitations, a feeling of 'heaviness' in the chest, as well as exercise intolerance, are often reported to improve considerably after treatment with the Vacuum Bell. Compared to other non-invasive treatments, such as Pectus implants, the Vacuum Bell offers physical benefits in addition to cosmetic improvements.

Rib flare is defined as when the lower ribs stick out more than usual, and is a common side effect of Pectus Excavatum. Results with rib-flare are mixed, as are those with surgical treatments. In some cases, the flaring can correct itself as the sternum is pulled back into a normal position.

If rib flaring is still noticeable after Vacuum Bell Treatment, specialist bracing is usually recommended to return the ribs to a normal position. Exercises can also help correct rib flare by strengthening the abdominal wall, which covers the ribs.

Vacuum Bell Therapy works on the soft cartilage of the front chest, rather than bone. Because of the tissue's softness, it can be easily moved by a small amount of suction. The following is a quote from Eckart Klobe that goes into detail describing the Vacuum Bell's mechanism of action.

"The vacuum performed by the Vacuum Bell pulls the breastbone from its concave position into a raised position, including the cartilaginous rib ends and costal arches, which are attached to the breastbone. With equivalent force, the inner flanks of the Vacuum Bell press on the human body. These forces create bending moments, predominantly in the breastbone area and at the funnel edges.

The bending moments at the funnel edges are counterbalanced by the anchorage of the ribs to the spinal column. Lifting of the Pectus funnel may involve 3 types of deformation at the bones, cartilages and ligaments of the ribcage:

• A reversible elastic deformation, predominantly occurring in children,
• Potential (micro-) ruptures, mainly occurring at the beginning of the treatment. Before they are healed, the patient’s ribcage may experience a temporary loss of firmness.
• A gradual growing transformation which may be regarded as permanent.

A partial return of the Pectus funnel into its concave position after removal of the device may be understood as a competition between the stability of the lifted rib cage and those muscles which pull from the inside, a competition which is still not yet won.

The inward-pulling muscles, such as the Diaphragm and Musculus Transversus Thoracis, are stretched by lifting the chest wall. As a result, these muscles adapt to their new position, and after removal of the device, they do not pull back that far or that strongly anymore. In many cases, this adaptation process takes longer than any other part of the treatment."

Most household activities are generally fine to do as normal while wearing the Vacuum Bell. Things you would normally do inside, such as homework, TV, and cooking, are usually perfectly OK.

Exaggerated upper-body movements, such as throwing or reaching, may cause the Vacuum Bell to detach. If this occurs, it won't cause any physical harm to the patient, and they can simply reapply the Vacuum Bell.

Our clinic works with USA based medical companies to supply our clients with medical-grade Vacuum Bell devices at an affordable price. Find out more about our Vacuum Bell treatment program, or buy a Vacuum Bell.