Non-Surgical Pectus Excavatum Treatment: A Guide

The main evidence-based non-surgical treatment for pectus excavatum is the vacuum bell, a silicone suction cup that gradually lifts the sternum. Its results depend heavily on age and consistency. Exercise can reduce how noticeable the chest looks but does not move the sternum. A chest support brace is an adjunct, not a proven standalone correction.

Key points

• The vacuum bell is the only non-surgical option with real outcome data. In a Swiss cohort at University Hospital Basel, about 80% of 140 patients showed significant improvement, and results turn on two things: starting while the cartilage is still pliable, and using the device consistently over months rather than weeks.
• Scaife and colleagues (2025, n=240) reported a successful outcome in 66% of patients, and Haecker and colleagues (n=133) reported comparable results. Both cohorts pool patients who started young and consistent with those who did not.
• Exercise and posture work increase muscle around the deformity and can make it look less noticeable, but they do not change the position of the sternum or the costal cartilage. Both halves of that are true and both matter.
• Cincinnati Children's Hospital reports the vacuum bell 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 who have a mild deformity.
• A chest support brace is worn alongside the vacuum bell to support posture and the chest wall. No cohort in this review measures bracing as a standalone treatment for pectus excavatum.
• After 20 years of clinical use, no validated guidelines for vacuum bell therapy exist (Haecker et al. 2024), and no randomised trial has tested any non-surgical option.

The short answer, expanded

Pectus excavatum, a sunken breastbone, is the most common anterior chest wall deformity, affecting roughly 1 in 400 people. When it is mild to moderate and the chest wall is still flexible, there are three non-surgical paths, and only one of them changes the underlying chest.

The first is the vacuum bell: a suction device that lifts the sternum and attached rib cartilage while worn, and, in the right patient, produces a change that partly persists over one to two years or more. This is the only non-surgical option with published outcome cohorts. The second is exercise and posture work, which builds muscle around the indentation and can make it look shallower without moving the bone. The third is a chest support brace, used as an adjunct rather than a proven corrective device in this deformity. Surgery remains the option for severe, rigid or symptomatic chests, and its cost and reversibility profile are covered below so the two routes can be compared honestly.

What the evidence actually shows

The vacuum bell: the option with outcome data

Vacuum bell therapy uses a silicone cup and a hand pump to create negative pressure over the sunken chest. The immediate lift is not in dispute: during minimally invasive surgical repair, surgeons have watched the sternum rise under the device through a thoracoscope (Haecker 2016, approximately 450 patients). The real question is whether repeated lifting produces a change that lasts once the device comes off.

The larger published cohorts are consistent with one another. Graded by improvement in the chest wall, the reported results were:

Cohort	Significant improvement
University Hospital Basel (n=140)	about 80%
Scaife and colleagues, 2025 (n=240)	66%
Haecker and colleagues (n=133)	comparable

These figures pool whole cohorts. The more useful point is what separates the people who respond from the people who do not. Two things dominate. Younger cartilage is more pliable, so adolescents typically respond faster and more completely than adults. And consistency of daily use over months, rather than weeks, is the single largest factor a patient actually controls. A pooled rate is therefore a floor that mixes well-selected consistent patients with late starters, not the result a young, consistent patient should expect.

Luo and colleagues (2022, n=139) followed preschool children with a mean age of 4.6 years in Frontiers in Pediatrics, tracking chest depth with a three-dimensional scanner. Forty-three children, or 30.9%, reached the endpoint of residual depth under 3 mm with a cosmetic result, with shallower starting depth (odds ratio 0.69) and a longer treatment period (odds ratio 1.58) predicting complete correction. This was short-term follow-up, so it shows that complete correction is achievable in very young, shallow chests, not that it holds for years.

Zhou and colleagues (2024, n=65) surveyed caregivers, an 84% response rate, in Frontiers in Pediatrics, and reported a mean treatment duration of 23.2 months. Caregivers rated the effect (Zhou et al. 2024) as excellent in 12.3%, good in 46.2% and moderate in 41.5% of cases, pooling children who used the device consistently with those who paused. These are subjective reports, not imaging, so read them as satisfaction rather than measured efficacy. The most useful figure in the paper is not an outcome at all. Thirty-nine of the 65 children (Zhou et al. 2024), or 60%, paused use for more than two weeks at least once. That is an adherence figure, not a correction rate. Set against how long the published cohorts actually ran, it shows why consistency, not the device, decides most outcomes.

Two external reference points frame the ceiling. Cincinnati Children's Hospital, a major paediatric centre with no product to sell, 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 who have a mild deformity. Separately, a single Swiss cohort in Basel (n=140) recorded approximately 80% significant improvement. That 80% is one selected cohort of patients who started early and stayed consistent, so read it as an encouraging single-centre result rather than a population average, and not as a general success rate.

Reported complications are mostly minor. Zhou and colleagues (2024, n=65) recorded petechiae, small pinpoint spots of broken capillary, in 44.6% of children during use. All of them resolved after a short pause in treatment, with no permanent sequelae. The device design received FDA clearance in May 2012 and carries CE certification, a clearance that applies to that specific device design (Klobe cohort). Reviewing 20 years of clinical use in the Journal of Thoracic Disease, Haecker and colleagues (2024) concluded the therapy is safe and a potential alternative to surgery in carefully selected patients, and that in children under 10 it appears a reasonable first step. They also stated plainly that no validated guidelines exist. It is formally indicated in mild-to-moderate deformity and in patients declining surgery (Loufopoulos et al. 2021).

Exercise and posture: appearance, not correction

Strength training and posture work are often presented as a way to fix a sunken chest without a device. The accurate version is narrower and it has two halves that must be stated together. Strength training increases the muscle mass around the deformity and can reduce how noticeable it appears. It does not alter the position of the sternum or the costal cartilage. In practice this means exercise is a reasonable adjunct for how the chest looks, especially in adults who are not pursuing structural change, but it is not a substitute for the vacuum bell if the goal is to move the chest wall itself. Anyone told that a specific routine will reshape the bone is being oversold.

Bracing: an adjunct, not a proven standalone

Bracing causes the most confusion, because compression bracing is a genuine primary treatment for pectus carinatum, the opposite deformity where the sternum protrudes. In pectus excavatum, where the sternum is sunken, a chest support brace is used to support posture and the chest wall alongside vacuum bell therapy, not as a device that lifts the sternum on its own. No cohort in this review measures a brace as a standalone correction for pectus excavatum, and none of the outcome data above should be read as evidence for bracing by itself in this deformity. It is best understood as a supporting part of a protocol, not a treatment in its place.

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 met.
• People who can stay consistent for years. Sustained daily use over months is the dominant factor in the outcome. Consistency here is a dosing requirement, not a virtue.
• Adolescents and adults with a flexible chest. Response rates fall after age 11 but the cohorts still include responders (Loufopoulos et al. 2021). Expect longer timelines, commonly 12 to 24 months or more.

Who this does not work for

This section matters more than the one above it. About half the largest published cohort did not respond, and the people in that half share recognisable features.

• Rigid chest walls. If the sternum does not visibly lift under suction, the mechanical precondition is absent and time will not supply it. This is common in deep, long-standing adult deformity, which is usually a surgical conversation.
• Severe deformity in an adult. A deep, ossified chest is a poor target for a device that works by gradual remodelling, and the honest advice there is to get a surgical assessment.
• People who will not use it daily for years. This is the largest single failure group, and it is not a character judgement. Sixty percent of children in one cohort paused for more than two weeks (Zhou et al. 2024, n=65). If daily use for a year or more is not realistic, the outcome data does not apply.
• Anyone expecting change in weeks. The immediate post-session lift is temporary and partly reverses within hours (Haecker 2016). Mistaking that for progress ends more courses than any biological factor.
• Pectus carinatum. A protruding sternum is the opposite deformity and needs compression, not suction. A vacuum bell is not indicated.
• Anyone relying on exercise alone for structural change. Muscle work changes appearance, not the position of the sternum, so it is not a corrective option on its own.

Anyone with breathlessness disproportionate to exertion, palpitations, chest pain or exercise intolerance should be assessed by a physician before considering any treatment, because those symptoms change the calculation and are not something a purchase should precede.

What this means in practice

Four things follow from the evidence above.

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 a flexible chest, the case for starting a conservative trial early is stronger than the case for watchful waiting, and it is worth raising with a paediatrician directly.

Adherence is the variable you can control, and it is the one that fails. The pause rate in the Zhou cohort, set against treatment that is measured in months rather than weeks, identifies the real failure mode. Haje and colleagues (2021, n=115) found structured support raised adherence from 58% to 83%, the gap between those who keep going and those who stop.

Match the option to the goal. If the goal is a structural change, the vacuum bell is the only non-surgical route with data, and exercise and bracing are supports around it, not replacements. If the goal is only how the chest looks and the deformity is mild, muscle work alone may be enough for an adult who accepts that the bone will not move.

The cost asymmetry is part of the decision. 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 (Nuss 1998). A vacuum bell system costs a few hundred dollars and can be stopped at any time. That asymmetry does not make conservative treatment the right answer, but it means a six-month trial carries a very different downside from a surgical decision, and conservative treatment 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. The specific gaps matter for anyone making a decision.

No randomised controlled trials. Every study here is retrospective, observational or survey-based. There is no randomised comparison of the vacuum bell against surgery, against a sham device, or against no treatment, and none for exercise or bracing in this deformity. That is the single largest evidentiary gap in the field.

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

Weak long-term durability data. Short-term cohorts such as Luo (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 conservative treatment and stay with it for two years differ systematically from those who do not, which likely makes published cohorts look more favourable than the general experience. No study in this review isolates bracing or exercise as a treatment on its own.

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, alongside post-session skin care, the written protocol, and scheduled follow-up. Surgical repair in the United States commonly runs 40,000 to 70,000 dollars and involves a bar in the chest for two to three years plus a second operation to remove it. The market-leading vacuum bell sells at 465 to 495 dollars for the device alone. Bought together, the bell, the brace and the gel are $461.40 for the men's line and $491.40 for the women's line, while an unguided marketplace device runs about 90 dollars, which the adherence data above puts in context. 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?
• How much does the Nuss procedure cost?
• Can exercise fix pectus excavatum?
• What size vacuum bell do I need?

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. Nuss D, Kelly RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of Pediatric Surgery. 1998.
9. 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.