Vacuum bell for pectus excavatum: how it works and what the evidence says
By Javier Santana, founder of Pectus Academy · Updated October 2026
Short answer: the vacuum bell is a silicone cup that uses negative pressure to lift the breastbone while you wear it. Used daily for one to three years, it reduces the dip in some patients, mostly young ones with a shallow, symmetric dip. It does not work in every case, the studies are of limited quality, and there is almost no data in adults.
What is it and how does it work?
It is a cup placed over the breastbone and connected to a hand pump. Pumping creates a vacuum that pulls the breastbone outward. That immediate effect has been confirmed by looking inside the chest during operations: the breastbone lifts on the spot.
The question is how much of that lift stays once you take it off, and that takes months of use. The original device comes in three sizes (16, 19 and 26 cm in diameter), with versions for women and for adults with a small, deep dip.
How long do you have to use it?
- At the start: the published schedule is a minimum of 30 minutes twice a day for the first 4-6 weeks. After that it can be worn for up to several hours a day.
- Total duration: 12 to 15 months in children with a mild, symmetric dip, and 24 to 36 months in teenagers and adults with a moderate dip.
- What matters most: in the Amsterdam study, wearing it more hours a day, using it at night and keeping it up for more months were linked to better results.
What results do the studies report?
| Study | Patients | Main result |
|---|---|---|
| Haecker, 2011 (Basel) | 133, aged 3 to 61 | 105 kept a lift of more than 1 cm after 3 months of daily use. 13 stopped and had surgery. |
| Lopez et al., 2015 | Not stated | Correction in 31.5% overall and in 37.5% of pediatric patients. |
| Haecker and Sesia, 2016 (Basel) | 140, aged 3 to 61 | 61 reached a normal breastbone level after 21.8 months on average. 25 stopped because of unsatisfactory results. |
| Alaca et al., 2020 (randomized trial) | 26 boys aged 11 to 18 | Bell plus physical therapy did better than the bell alone at 12 weeks. |
| van Braak et al., 2025 (Amsterdam) | 259 | Success in 86 of the 165 who completed treatment (52.1%). |
| SHTG, 2025 (assessment of 15 studies) | Various | Positive results in roughly 20-50% in recent studies. Evidence prone to bias. |
The figures are not comparable with each other: each study defines “success” differently, and almost all count only those who finished treatment.
Who does it work best for?
- Better: a mild, symmetric dip, little depth, a flexible chest and consistent use.
- Worse: a deep dip. The group most at risk of failure is severe, asymmetric pectus with a stiff chest wall.
- Age: the studies disagree. The Scottish assessment points to better results in younger patients; the Amsterdam study found no significant link between age and success.
What are the side effects?
Those reported are minor and mostly skin-related. In Amsterdam they occurred in 22.8% of patients (skin discoloration in 11.2% and pain in 6.2%). In Basel: skin irritation in 13.6%, pain during application in 12.1% and bruising in 7.1%. Small spots of bleeding in the skin, back pain and temporary tingling in the arms have also been described. The Scottish assessment found no relevant safety concerns.
Who should not use it?
It is contraindicated in people with musculoskeletal disorders, blood vessel disease, clotting problems or heart disorders.
In the published series, patients have an electrocardiogram and an echocardiogram before starting, the first application is done in the clinic, and there are check-ups every 3 to 6 months. It is not a device to buy and use on your own: start with your doctor.
What we know and what we don't
What we know
- It lifts the breastbone while it is worn.
- In some patients the improvement lasts: in Basel there was no regression over an average follow-up of 27.6 months.
- The side effects reported are minor.
- Adding physical therapy improved results in one small trial.
What we don't know
- Whether results last in the long term: published follow-up after stopping covers only a few years.
- How well it works in adults. We cover that in does the vacuum bell work in adults?
- What the best schedule of hours and pressure is.
And at Pectus Academy?
The 16-week program includes a module on the bell: how to position it, how to progress and when to stop.
For the full picture of options, read can you fix pectus excavatum without surgery?
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
- Obermeyer RJ. Incorporating vacuum bell therapy into pectus excavatum treatment. Journal of Visualized Surgery, 2016;2:99. Source of the Lopez et al. figure.
- 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
- 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.