Can you fix pectus excavatum without surgery? What the evidence says
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: yes, in many cases you can: surgery is not the only way. The vacuum bell lifts the breastbone and, used consistently, reduces the dip in some patients; in the largest study it was considered a success in half of those who completed treatment. Posture, breathing and strength work can change how the chest sits and improves how it looks, and in one trial it added to the bell. That is how I corrected mine, starting at 33. What nobody can give you is a guarantee: it depends on your age, how deep the dip is, how flexible your chest is and how consistent you are. Almost all the studies are in children and teenagers; there is less data in adults. Severe or symptomatic pectus is a matter for a doctor.
What is pectus excavatum?
It is a breastbone that sinks into the chest. It is also called sunken chest or funnel chest. It appears in 1 in 300 to 1 in 1,000 births and is about five times more common in males.
For many people the only sign is a slight dip in the middle of the chest. In severe cases the breastbone can press on the heart and lungs and cause shortness of breath, chest pain or less stamina during exercise. The dip can keep getting deeper into adulthood.
What does “fixing” it mean?
Two things often get mixed up:
- Visual correction: how the chest looks. It depends on posture and on the muscle around the dip. A rounded back and forward shoulders tend to make it stand out more.
- Structural correction: changing the position of the breastbone and the cartilage. It is not exclusive to surgery: the vacuum bell achieves it in some cases. And the chest is not rigid: the ribs join the breastbone through flexible cartilage, especially in young people, so posture, breathing and strength work can also change how it sits.
The two are worked on at the same time, and that is what a complete program does. If someone promises you a result, ask how they measured it.
What are the non-surgical options, and what is the evidence?
| Option | What it can change | What the evidence says |
|---|---|---|
| Exercise and physical therapy | Posture, strength and chest expansion | Some exercises may improve posture and how far the chest can expand. In one trial, adding them to the bell gave better results than the bell alone. |
| Vacuum bell | Depth of the dip, in some cases | In a study of 259 patients, 52.1% of the 165 who completed treatment considered it a success. A review of 15 studies found positive results in roughly 20-50% in the most recent ones, though the studies are prone to bias. |
| Vacuum bell plus physical therapy | Depth and posture | A small trial (26 boys aged 11 to 18, 12 weeks) got better results than with the bell alone. |
| Strength training | Muscle volume around the dip | It changes the outline around the dip. |
Does the vacuum bell work?
The vacuum bell is a silicone cup placed over the breastbone. A hand pump creates negative pressure and lifts the breastbone while you wear it. It is used daily for months: published schedules range from 30 minutes twice a day to several hours, for a year or more.
In the largest study so far (Amsterdam, 259 patients), it was considered a success in 86 of the 165 who completed treatment. Wearing it more hours a day and for more months was linked to better results; a deeper dip, to worse results. Minor complications, mostly skin-related, occurred in 22.8% of patients.
The Scottish health technology assessment (2025) found no relevant safety concerns, but warns that almost all the studies are retrospective and prone to bias. The best results are seen in young patients with a flexible chest, a shallow dip and the motivation to use it.
The bell has contraindications, including clotting, bone and cardiovascular problems. Talk to a doctor before using it.
What about exercises, posture and breathing?
They are the foundation: the lowest-risk part and the one that depends only on you. They may improve posture and chest expansion, and in the trial above those who combined them with the bell got better results than with the bell alone.
This is the work our 16-week program organizes: mobility, breathing, posture and targeted training, with a module for anyone who wants to add the bell. It is the method I used to correct my own pectus.
Can adults do anything?
Yes. Posture and muscle can be trained at any age. On the vacuum bell in adults there is almost no data: it has been used in people up to 61 years old, but there are hardly any published results specific to adults, and sources such as Mayo Clinic describe it as a treatment for children and teenagers. Surgery is also done in adults in some cases.
I started at 33, with posture, breathing, training and, for more than a year, a vacuum bell. Today my pectus is corrected; that is why Pectus Academy exists. That is my experience, not a study, and I cannot promise you the same result: every chest is different.
When is surgery needed?
Severity is measured with the Haller index, calculated on a CT scan by dividing the width of the chest by the distance from the breastbone to the spine. Up to 2.5 is considered normal; above 3.2, a severe deformity. The main reason to operate is that the dip affects the heart or lungs, not appearance.
The two usual techniques are the Nuss procedure, which places a curved metal bar under the breastbone through small incisions and removes it after two or three years, and the older Ravitch technique, with a larger incision down the center of the chest.
See a doctor before starting anything if you notice shortness of breath, chest pain, palpitations, fainting, or you tire more than usual during exercise.
What we know and what we don't
What we know
- Surgery is the established treatment for severe or symptomatic cases.
- Correction without surgery exists too: the vacuum bell reduces the dip in some patients, mostly young ones with a shallow dip who use it consistently.
- Adding physical therapy to the bell improved results in one small trial.
- Exercise may improve posture and chest expansion.
What we don't know
- How well the vacuum bell works in adults.
- Whether its results last in the very long term.
- How much exercise adds on its own: the studies have measured it together with the bell, not separately.
Where to start
- If you have symptoms or a deep dip, start with a doctor.
- Work on posture and breathing: it carries the least risk.
- If you are considering the bell, do it with medical guidance and consistency.
For step two, get our free guide to the 4 posture mistakes.
Keep reading
Understanding pectus
- What is pectus excavatum?
- Mild vs severe: when to see a doctor
- Haller index, with calculator
- Pectus excavatum vs pectus carinatum
- Self-check list for your appointment
Vacuum bell
- How it works and what the evidence says
- How many hours a day and for how long
- How to choose the size
- Side effects and contraindications
- Vacuum bell and exercises
- Does the vacuum bell work in adults?
Exercise and posture
- Exercises: what helps and what doesn't
- Posture and rib flare
- Breathing exercises
- Pectus excavatum and the gym
- Pectus excavatum and sports
- Visual improvement vs structural correction
Depending on your case
- Pectus excavatum in adults
- Is it too late at 20, 30 or 40?
- Children and teenagers: a guide for parents
- Body image and confidence
- Surgery vs conservative treatment
- The studies, summarized
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: symptoms, causes, diagnosis and treatment. mayoclinic.org
- van Braak H, de Beer SA, al Ghouch Y, et al. 15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors. Journal of Pediatric Surgery, 2025;60(2):161891.
- Scottish Health Technologies Group. Vacuum bell device for the correction of pectus excavatum, June 2, 2025. shtg.scot
- Alaca N, Alaca I, Yuksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interactive Cardiovascular and Thoracic Surgery, 2020;31(5):661-668. doi.org/10.1093/icvts/ivaa161
- Haecker FM, Sesia S. Vacuum bell therapy. Annals of Cardiothoracic Surgery, 2016. pubmed.ncbi.nlm.nih.gov/27747177
Prefer a structured plan? See the 16-week program.