Vacuum bell: how many hours a day and for how long
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: the published schedule starts with 30 minutes twice a day for the first 4-6 weeks and then builds up to several hours a day. In the Basel series, treatment is planned for 12 to 15 months in children with a mild, symmetric dip and 24 to 36 months in teenagers and adults with a moderate one; that is not a guaranteed timeline. No optimal number of hours or pressure has been proven: what studies link to better results is wearing it more hours a day and for more months.
These are published schedules, not a schedule for you: your doctor sets yours.
How do you start?
The first application is done in the clinic, with the doctor present. That is where you learn to position it, with the middle of the window over the deepest point of the dip. After that, at home, the published minimum is 30 minutes twice a day for the first 4-6 weeks.
How many hours a day, and how many months?
| Source | Hours a day | Duration |
|---|---|---|
| Basel, 2016 | A minimum of 30 minutes twice a day; later, up to several hours. Some teenagers wear it all night (7-8 hours) and some adults up to 8 hours during office hours | 12-15 months in children with a mild, symmetric dip; 24-36 months in teenagers and adults with a moderate one, over 3 cm |
| Mayo Clinic | One or more hours a day, in children and younger teens | About 12-15 months |
| Lei et al., 2024 | Not stated in the abstract | Using it for more than 24 consecutive months was linked to better results |
| Amsterdam, 2025 | More hours a day and nighttime use, better results | More months of use, better results |
In the 2016 Basel series, the 61 patients who reached a normal breastbone level took 21.8 months on average (range 6 to 69 months).
How much pressure should you apply?
The Basel series gives no target figure: the strength of the vacuum is checked at follow-up visits using the device's own pressure gauge. We have not found any study comparing pressure levels, so be wary of figures that circulate without a source.
When do you see changes?
In the 2011 Basel series, 105 of 133 patients showed a lift of more than 1 cm at 3 months. That is not the final result: those who reached a normal level took almost two years on average. Follow-up visits take place every 3 to 6 months, with depth measurements and photos.
What matters most for the result?
- Wear time: more hours a day, nighttime use and more months were linked to better results in Amsterdam.
- Starting age: the studies disagree. In Lei et al., starting at age 11 or younger was linked to better results; in Amsterdam there was no significant link with age.
- Type of pectus: better with a shallow dip and a flexible chest; worse with a deep, asymmetric, stiff one.
- Consistency: in Basel, 25 of 140 patients stopped after 15.7 months on average because of unsatisfactory results or fading motivation.
Can you wear it at night?
It has been described: in Basel some teenagers wear it all night, and in Amsterdam nighttime use was linked to better results. If you are considering it, get your doctor's go-ahead. Under age 10, an adult should supervise each application.
When do you stop?
In Basel, the patients who reached a normal level stopped using the bell and, over an average follow-up of 27.6 months, there was no regression. If the measurements do not change after several months of consistent use, rethinking it with your doctor is reasonable. And if you get any discomfort, check side effects and contraindications first.
What we know and what we don't
What we know
- How treatment starts and how long the published treatments last.
- That more hours and more months of use are linked to better results.
What we don't know
- The ideal number of hours.
- Which pressure level gives the best result.
- Whether results last in the long term: published follow-up after stopping covers only a few years.
Keep reading
- Vacuum bell: how it works, with a table of studies
- How to choose the size
- Does the vacuum bell work in adults?
The 16-week program includes a module on the bell for those using one with their doctor. It is not a device to buy and use on your own: start with your doctor.
This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.
Sources
- Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatric Surgery International, 2011;27(6):623-627.
- Haecker FM, Sesia S. Vacuum bell therapy. Annals of Cardiothoracic Surgery, 2016. annalscts.com
- Mayo Clinic. Pectus excavatum: diagnosis and treatment, updated March 14, 2025. mayoclinic.org
- Lei W, Shao M, Hu Y, et al. Vacuum bell therapy for pectus excavatum: a retrospective study. BMC Pediatrics, 2024;24. doi.org/10.1186/s12887-024-04615-3
- 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
Prefer a structured plan? See the 16-week program.