Vacuum Bell Therapy

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.

The frontal area of the chest affected by Pectus Excavatum is made up of semi-flexible material known as 'intercostal cartilage'. This can be moved with relatively little force. The mild negative pressure created by the Vacuum Bell lifts the chest up into a normal position after a short period, usually around 30 minutes.

The Vacuum Bell Device is often prescribed by doctors and pectus clinics for patients who opt for a non-invasive Pectus Excavatum treatment. The device does not work with Pectus Carinatum.

Yes, there have been multiple clinical studies done using the Device with Pectus Excavatum since 2007. These have all reported good levels of success for 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 from 165 patients using 12-24 months treatment length.

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 were longer hours of daily Vacuum Bell Treatment, overnight use and a prolonged treatment duration.

A flexible thorax, deeper deformity and symptomatic pectus were related to 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 who seeks a non-invasive alternative to surgery for Pectus Excavatum is a possible candidate for the Treatment, however, age and depth severity are useful to determine the patients most likely to have better outcomes.. According to Dr. Frank-Martin Haecker, who is a major pioneer in the field of Vacuum Bell Therapy and has authored major on the subject:

"In general, Vacuum Bell Therapy is feasible at nearly any age. Patients age and patients 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 between 6-18 have been observed to have better permanent outcomes with the Therapy, due to growth factors and the flexibility of the chest wall. Therefore, It's best to start treatment as early as possible, even as young as 7 years of age, before the sunken chest begins to worsen in 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 so much a problem with under 18 patients, and full correction is often still observed in even moderate depths with those patients, 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 Device can still be used to offer some degree of relief in cases where the patient either wishes to avoid surgery or cannot access it.

Another note to be aware of is that with older patients (over 18), the chest wall is usually stiffer and requires more vacuum pressure to effectively move the chest. After some time using the Device (usually a minimum of 4 weeks), the chest wall will gradually soften up 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 along different stages of the treatment.

Vacuum Bell Treatment should be avoided in patients with certain conditions, such as:
Skeletal diseases that affect the firmness of the bones, such as 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 Vacuum Bell Therapy is 12 months for patients under 13, and 24 months for all others. 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 results have only been scientifically documented with 12-24 month treatment lengths.

Common side-effects of Vacuum Bell Treatment include: skin bruising, reddening and discoloration. These usually stop completely after continued use when less pressure is needed to lift the sternum. 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 Therapy cites the following common side effects: "During the first five applications, most of the patients experienced moderate pain in the sternum and report a feeling of uncomfortable 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, such as transient paresthesia of the upper extremities during the 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 application children under 10 years. 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 is freed up to move back to it's natural position and can often crack.

Consistent daily use is required to effectively treat Pectus Excavatum. 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.

Results are usually seen after the first session, but for permanent gains, the Device should be used for at least 12-24 months. Posture improvements and relief from cardiopulmonary symptoms begin immediately once the sunken chest has lifted, usually after the first session. You can maintain these results with everyday use and sticking with your treatment protocol.

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

Yes, according to a 2016 comprehensive meta study on Vacuum Bell Therapy it shows excellent results with asymmetrical pectus. Most of the studies conclude that patients with asymmetry can achieve the same results as those without. They do note that some presence of chest asymmetry is usually still visible after the chest has been corrected.

Pectus patients who are beginning Vacuum Bell Therapy should start with a slow and gradual approach. It's recommended to lift the pectus deformity gradually over the course of 4-6 weeks until it touches the glass on the Device. This method is recommended by some doctors and pectus clinics because they believe it may lead to better outcomes with treatment, although there are no scientific studies to determine this. The idea behind it is to attempt to maintain the firmness of the chest-wall and stop the chest sinking back in 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 length of time of daily application of the Vacuum Bell will vary widely between patients. Some of the adult patients use the Device up to 8 hours daily during office hours, whereas adolescent boys may apply the Device every night for 7–8 hours. In our experience, the duration and frequency of daily application depends 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 wearing hours. 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 pectus 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 surgeon regard the result as aesthetically pleasing and therapy is stopped.".

The Device should be wide enough to cover the entire pectus deformity, but ideally not cover the nipples. The middle of the Device should be centred over the deepest point of the pectus deformity. It can also be worn sideways and diagonally to fit asymmetrical cases. 

Hair on the chest can interfere with the seal of the Device. If you notice a slow loss of suction, it might be necessary to shorten it by shaving. A correctly functioning Vacuum Bell Device should not lose air pressure when applied to smooth skin.

Before applying, it's important to get the upper body into a neutral posture. Pectus Excavatum often pulls the upper body forward into kyphosis (slouched posture).  To get the upper body straight, try lying down flat on a bed, either with or without a pillow. You can also try lying on a harder surface, such as the floor. Another method is to lean back into a chair while pushing the chest out.

Once in position, you can apply the Device and begin squeezing the hand pump. Experiment with different positions when applying and use the one that yields the best results.

No, Vacuum Bell Treatment has been proven through clinical studies and with medical imaging to physically move the sternum to a normal position, the same as would be achieved with the Nuss Procedure for Pectus Excavatum. Examples of this can be seen clearly in Vacuum Bell before and after photos.

The misconception that Vacuum Bell Therapy gives only cosmetic results may have arisen from a popular misconception that the chest wall is made up of bone and can't be moved.

Whilst 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 with the Treatment.

Pectus Excavatum 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 with Vacuum Bell Treatment

When compared with other non-invasive treatment methods, such as pectus implants, Vacuum Bell Treatment ranks superior for being able to offer physical symptom relief, as well as cosmetic improvement.

Rib flare is defined as when the lower ribs stick out more than usual and is a common side effect with Pectus Excavatum. Results on rib-flare are mixed, as is also the case with surgical treatments. In some cases, the flaring can correct itself as the sternum is pulled back into a normal position; this is evident in the young patient photographed in the top section of this article. 

If rib flaring is still noticeable after Vacuum Bell Treatment, specialist bracing is the recommended method of treatment to correct the ribs into a normal position. Exercise is also useful to correct the posture and thicken the abdominal muscles that cover the ribs.

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

"The vacuum performed by the Device 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 Device 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 ribcage 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 strong any more.

In many cases, this adapting process takes longer than any other part of the treatment."

Most household activities are generally fine to do as normal while wearing the Device. Things you usually perform inside, such as homework, TV, cooking, and the like are all usually perfectly OK. It is only exaggerated upper body movements, like throwing or reaching, that may cause it to detach.

Yes, exercise is recommended to help enhance the effects of the treatment, and can even be done with the device on. Most Pectus Excavatum patients usually present with secondary issues such as: 'pot-belly', flared ribs, and hyper-lordosis (anterior pelvic tilt). Exercises for Pectus Excavatum are a proven way to correct these conditions.

Furthermore, after the first treatment session, you may notice a significant improvement in your upper body posture. This is because the pectus deformity often pulls the upper body forward into kyphosis (forward slouching). To help enhance this process and make it permanent, it's recommended to incorporate some form of upper body posture correction as well, such as foam rolling or stretching.