FormaChest Vacuum Bell FAQ: Your Top Questions Answered

Vacuum bell therapy improves pectus excavatum for a meaningful share of well-selected patients, and the odds depend on age and consistency. Younger cartilage is more pliable, so adolescents typically respond faster than adults. In a Swiss cohort from Basel, about 80% of patients showed significant improvement (Basel cohort, n=140).

Key points

• Scaife and colleagues (2025, n=240) reported a successful outcome in 66% of patients, and Haecker and colleagues (n=133) reported comparable results.
• Two things separate responders from non-responders: starting while the cartilage is still pliable, and using the device consistently over months rather than weeks.
• In a Swiss cohort from Basel, about 80% of patients showed significant improvement, a pooled figure that does not segment by age (Basel cohort, n=140).
• Cincinnati Children's Hospital reports the therapy may remove the need for surgery in up to 35% of patients who use it, with the strongest results in children aged 6 to 12 with a mild deformity.
• The most common reason treatment fails is adherence, not the device. Zhou and colleagues (2024, n=65) found 60% of children paused use for more than two weeks, which works against the consistency the outcome data rewards.
• After 20 years of clinical use, no validated international guidelines for the therapy exist (Haecker et al. 2024).

The short answer, expanded

This page collects the questions people ask most often before starting vacuum bell therapy, and answers each one from the published literature rather than from marketing. The device uses a silicone suction cup and a hand pump to create negative pressure over the sunken part of the chest, lifting the sternum and the attached rib cartilage while it is applied.

The honest summary is that this is not a treatment with a single success rate. It is a treatment with a strongly age-dependent and adherence-dependent success rate, and reporting one headline number without those two variables attached would mislead. The sections below take the common questions in turn, name the study behind each answer, and state plainly who the therapy does not suit.

What the evidence actually shows

Is there a 90 percent success rate?

No reliable 90 percent figure exists in the peer-reviewed literature, and any single headline rate is misleading because outcomes split sharply by age and consistency. The larger cohorts report rates rather than one headline number. Scaife and colleagues (2025, n=240) reported a successful outcome in 66% of patients, and Haecker and colleagues (n=133) reported comparable results. These figures pool every patient together, including late starters and those who stopped early, so they read as a floor rather than the expectation for a well-selected, consistent patient. A Swiss cohort from Basel reported significant improvement in about 80% of patients (Basel cohort, n=140), a higher figure that again does not segment by age.

What do the outcome studies report?

Two further reference points help. Luo and colleagues (2022, n=139) followed preschool children with a mean age of 4.6 years and found that 30.9% reached the study endpoint of residual depth under 3 mm with a cosmetic result, with shallower starting depth and a longer treatment period independently predicting complete correction. This was short-term follow-up, so it speaks to reaching correction rather than to whether it holds. Cincinnati Children's Hospital, a major paediatric centre with no product to sell, states publicly that the therapy may remove the need for surgery in up to 35% of patients who use it, with the strongest results in children aged 6 to 12 with a mild deformity.

Is the immediate lift real?

Yes. The sternum and attached rib cartilage lift while the device is applied, and this has been observed directly. During minimally invasive surgical repair, surgeons have watched the sternum rise under the device through a thoracoscope (Haecker 2016). The open question is whether repeated lifting produces a change that persists once the device comes off, which is what the outcome cohorts above try to measure.

How long does it take?

Published cohorts describe the therapy in years, not months. Zhou and colleagues (2024, n=65) reported a mean treatment duration of 23.2 months, and Cincinnati Children's Hospital describes the device as worn daily over one to two years. The daily commitment is a minimum of 30 minutes twice daily during an initial period, extending to several hours daily thereafter (Haecker 2016).

What is the most common reason it fails?

Adherence, not the device. Zhou and colleagues (2024) found that 39 of the 65 children, or 60%, paused use for more than two weeks at least once, which works directly against the consistency the outcome data rewards. This is an adherence figure, not a correction rate. Set against a therapy whose published cohorts run for years, it explains why real timelines stretch. Haje and colleagues (2021, n=115) found that structured support raised adherence from 58% to 83%.

What sizes are there, and is the design FDA cleared?

Reviews describe three device diameters plus a model fitted for adolescent and adult female patients (Loufopoulos et al. 2021, n=13 studies). The Klobe vacuum bell design received FDA clearance in May 2012 and carries CE certification, which applies to that device design rather than to any single seller (reported in Haecker). Correct sizing depends on measurements only you can take, which is covered in the practice section below.

Who this works best for

The published predictors are consistent enough to state directly.

• Children and younger adolescents. Cartilage that has not begun to ossify responds to sustained deformation, which is why this group typically responds faster than adults.
• Shallow to moderate depth. Shallower initial depth independently predicted complete correction in the preschool cohort (Luo et al. 2022, n=139).
• A flexible chest wall. Where the sternum visibly lifts under the device, the mechanical precondition is satisfied.
• Consistent users. Sustained daily use over months is the dominant factor in the outcome. Consistency here is a dosing requirement, not a virtue.

Who this does not work for

This section matters more than the one above it, because a large share of patients do not respond and they share recognisable features.

• Rigid, ossified chests. If the sternum does not visibly lift under suction, the mechanical precondition is absent and time does not supply it. This is common in deep, long-standing adult deformity, which is usually a surgical conversation.
• People who cannot use it daily for years. This is the largest single failure group and it is not a character judgement. Sixty percent of children in the Zhou cohort paused for more than two weeks at least once (Zhou et al. 2024). If a minimum of 30 minutes twice daily, building toward several hours, is not realistic in your life right now, the outcome data does not describe your case.
• Anyone expecting change in weeks. The immediate post-session lift is temporary and partially reverses within hours (Haecker 2016). Mistaking that for durable progress ends more courses than any biological factor.
• Pectus carinatum. A protruding sternum is the opposite deformity and needs compression bracing, not suction. A vacuum bell is not indicated.

Cardiac conditions, coagulopathies or bleeding disorders, vasculopathies, skeletal disorders of the thoracic wall and active skin disease over the treatment area all require clinical clearance before starting. Anyone with breathlessness disproportionate to exertion, palpitations, chest pain or exercise intolerance should be assessed by a physician first, because those symptoms change the calculation and are not something a device purchase should precede.

What this means in practice

Three things follow from the evidence.

Age is the variable you cannot get back. Cartilage stiffens steadily as a child grows, so every month of delay narrows the window in which the chest responds most readily. If a young child has pectus excavatum and the chest is flexible, the case for starting a conservative trial early is stronger than the case for watchful waiting, and this is worth raising with a paediatrician directly.

Adherence is the variable you can control, and it is the one that fails. Structured support, skin management and scheduled review all act on the pause rate that lengthens real courses (Haje et al. 2021, n=115). Measure in the morning, before the first session, using the same landmarks and posture each time, because post-session measurements capture temporary lift and tell a flattering story that collapses later.

The downside of a trial is small next to the alternative. Surgical repair in the United States commonly runs 40,000 to 70,000 dollars, with uninsured cases reported up to 100,000, and involves a bar in the chest for two to three years plus a second operation to remove it. A vacuum bell trial costs a few hundred dollars and can be stopped at any time. Six months of consistent use is usually enough to see whether a chest is responding, and stopping closes no surgical door.

Not sure whether this applies to you?

The two questions this article cannot answer for you are whether your own chest is a reasonable candidate, and which device size fits it. Both depend on measurements only you can take.

The FormaChest assessment takes about four minutes. It screens your situation against the variables the research identifies as predictive (age, depth of the indentation, chest flexibility and symptoms) and returns an honest read on whether conservative treatment is a reasonable first step. That includes telling you when the answer is to see a surgeon first, which it does for roughly the situations described in the section above.

It also returns a vacuum bell size recommendation based on your own measurements, at no cost.

Sizing is normally not free or simple in this category. The usual process is to email photographs of your bare chest to a company and wait for a reply, or to print paper templates and tape them to yourself, with the manufacturer warning that self-measurement may produce the wrong model. The assessment asks for numbers you can take alone with a ruler. No photographs, no email exchange, no deposit.

Take the free assessment →

What the research does not tell us

Presenting this literature as settled would misrepresent it. Several gaps matter.

No randomised controlled trials. Every cohort cited here is retrospective, observational or survey-based. There is no randomised comparison of vacuum bell therapy against surgery, against a sham device, or against no treatment. That is the largest evidentiary gap in the field.

No validated guidelines. Haecker and colleagues (2024) state this explicitly after 20 years of clinical use. Daily hours, session length, suction pressure and total course length vary between centres, which is a large part of why reported figures disagree.

Weak long-term durability data. Short-term cohorts such as Luo and colleagues (2022, n=139) show correction can be reached, but whether it holds through later growth is not well established.

Selection bias throughout. Patients who choose a conservative treatment and stay with it for two years differ systematically from those who do not, which likely makes published figures look more favourable than the general experience.

About this guide This article is published by FormaChest, a European manufacturer of vacuum bell correction systems, registered in Romania as AUGUMENTUM SRL. We make the device described above, and every figure quoted is cited to its source so you can verify it independently. The adherence problem described in this article is the reason FormaChest ships the bell, brace and gel together rather than a device alone: the vacuum bell, a chest support brace, post-session skin care, the written protocol, and scheduled follow-up. Sold as a set, the bell, brace and gel are $461.40 in the men's line and $491.40 in the women's line, where the rest of this category sells the device alone. See what is included →Tomas Titus is the founder of FormaChest (AUGUMENTUM SRL, Craiova, Romania). He had pectus excavatum and corrected it without surgery, documenting his own vacuum bell treatment on camera, taking each measurement before a session rather than after. His chest depth went from 25mm to 4mm. That is one person's result at 19; published adult timelines run 12 to 24 months and results vary. He is not a clinician, and nothing in this article is a substitute for assessment by one.

Related questions

• What is pectus excavatum?
• Does the vacuum bell actually work?
• What size vacuum bell do I need?
• How long does vacuum bell therapy take?

References

1. Scaife ER, et al. Vacuum bell therapy for pectus excavatum. 2025. n=240
2. Luo D, Cheng K, Yuan M, Xu C, He T. Efficacy and determinants of vacuum bell treatment in preschool children with pectus excavatum. Frontiers in Pediatrics. 2022. PMID 36313864
3. Zhou L, Deng F, Tian Y, et al. Questionnaire-based subjective evaluation of factors influencing vacuum bell treatment effectiveness in children with pectus excavatum. Frontiers in Pediatrics. 2024. DOI 10.3389/fped.2024.1467215
4. Haecker FM. Vacuum bell therapy. Annals of Cardiothoracic Surgery. 2016. PMID 27747177
5. Haecker FM, et al. 20 years clinical application of the vacuum bell for conservative treatment of pectus excavatum. Journal of Thoracic Disease. 2024. PMID 39268139
6. Loufopoulos I, Karagiannidis IG, Lampridis S, Mitsos S, Panagiotopoulos N. Vacuum Bell: Is It a Useful Innovative Device for Pectus Excavatum Correction? Turkish Thoracic Journal. 2021. PMID 35110237
7. Haje SA, et al. Adherence in conservative treatment of pectus deformities. 2021. n=115
8. Cincinnati Children's Hospital Medical Center. Vacuum bell therapy for pectus excavatum. Patient education resource.

This article is for information only and is not medical advice. Pectus excavatum should be diagnosed and assessed by a qualified physician. If you have chest pain, breathlessness, palpitations or reduced exercise tolerance, seek medical assessment before beginning any treatment.

Last reviewed: July 2026.