Pectus excavatum: visual improvement vs structural correction
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: they are two different things. Structural correction changes where the breastbone sits: that is what surgery does and, in some cases, the vacuum bell. Visual improvement changes how the chest looks: posture, muscle and breathing. We have not found studies measuring whether exercise alone changes the structure; what the sources do report is that it can improve posture and chest expansion.
What does each method act on?
| Method | What it acts on | Type of change in the studies |
|---|---|---|
| Posture and mobility | Rounded shoulders, hunched back, rib flare | Visual |
| Muscle | The outline around the dip | Visual |
| Breathing | How much the chest expands | Functional |
| Vacuum bell | The depth of the dip, in some patients | Structural, partial |
| Surgery | The position of the breastbone | Structural |
What evidence is there for each?
- Structural, with surgery: it is the option with the most studies and the established treatment for severe cases or those with symptoms.
- Structural, with the bell: limited. Recent studies show positive results in roughly 20-50% of selected patients, almost all children and teenagers.
- Visual and functional, with exercise: scarce. Mayo Clinic says some physical therapy exercises may improve posture and chest expansion, and in one small trial physical therapy added to the bell improved posture.
Can exercises move the breastbone?
We have not found studies that measure it. Seattle Children's Hospital sums it up this way: no medication or exercise has been shown to improve pectus excavatum. The chest is not rigid, though: the ribs join the breastbone through flexible cartilage, especially in young people. I managed to change mine with exercise and posture work; that is why Pectus Academy exists. That is my experience: it has not been measured in a study, and I cannot promise you the same result. If you see a “before and after”, check that the posture, the light and the angle are the same in both photos.
Why does posture affect how the chest looks?
Because pectus often comes with a typical posture. Mayo Clinic describes how many people with pectus have a hunched posture, with flared ribs and rounded shoulders. That posture changes how the chest looks. When posture improves, the chest can look different. We cover this in posture and rib flare.
Does muscle cover the dip?
Only partly. The chest muscle grows on either side of the breastbone, not over it, so the center of the dip does not fill in with muscle. What can change is the outline. More in pectus excavatum and the gym.
How is each one measured?
- Structure: with the Haller index or the correction index, both taken from a CT scan, and with the depth in centimeters measured at vacuum bell check-ups.
- Appearance: with photos always taken the same way: same light, same distance, same posture, front and side. That is a practical rule, not a clinical measurement.
Which one should I go for?
It depends on your case. If you have symptoms or the pectus is severe, the conversation is structural and it is with a surgeon: see mild vs severe pectus excavatum. If a doctor has ruled out an effect on the heart or lungs, what many people want is to look and feel better, and that is a visual improvement.
For me, posture is the main thing. As it improved, I felt better about how I looked and better overall. That is my experience, not proof of what will happen to you.
What does Pectus Academy offer?
The 16-week program combines both: posture, breathing and muscle for the visual and functional side, and a module on the vacuum bell, which is the part that acts on the breastbone, for those using one with their doctor.
What we know and what we don't
What we know
- Surgery changes the structure; the bell does in some cases.
- The chest is not rigid: the cartilage joining the ribs to the breastbone is flexible, especially in young people.
What we don't know
- How much appearance and the dip change with posture and exercise: we have not found good studies measuring it.
- How long that improvement lasts if you stop working on it.
Keep reading
- Can you fix pectus excavatum without surgery?
- Exercises: what helps and what doesn't
- Surgery vs conservative treatment
This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.
Sources
- Seattle Children's Hospital. Pectus Excavatum. seattlechildrens.org
- Mayo Clinic. Pectus excavatum: diagnosis and treatment, updated March 14, 2025. mayoclinic.org
- Mayo Clinic. Pectus excavatum: symptoms and causes, updated March 14, 2025. mayoclinic.org
- 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. annalscts.com
- Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
- St Peter SD, Juang D, Garey CL, et al. A novel measure for pectus excavatum: the correction index. Journal of Pediatric Surgery, 2011;46(12):2270-2273.
Prefer a structured plan? See the 16-week program.