Surgery vs. FormaChest
Surgery puts a metal bar behind the sternum. There is another way.
Before you sign a consent form, know exactly what the procedure involves, and what the alternative is.
What the Nuss procedure involves
Surgeons make two incisions on either side of the chest. A curved metal bar, made of surgical steel or titanium, is threaded through the chest cavity behind the sternum and flipped to force the chest wall outward. It is then bolted to the ribs and left in place for 2 to 3 years.
This is not a minor procedure. It is classified as a major thoracic surgery. It is performed under full general anesthesia, requires several days in hospital, and post-operative pain is commonly managed with prescription opioids.
Most patients spend the first week unable to sit up without help, miss 4 to 6 weeks of school or work, and are kept off physical activity for about 6 months. The bar stays in until a second surgery removes it.
Complications reported in the surgical literature
Published outcome studies of the Nuss procedure report the following complications:
- Bar displacement: the most common complication. The bar shifts inside the chest and can need re-operation
- Pneumothorax (collapsed lung): documented in multiple series, occurring during or after bar insertion
- Cardiac perforation: rare, but documented during bar insertion
- Pleural effusion: fluid around the lungs requiring drainage
- Allergy to implant material: requiring bar removal and repeat surgery
- Pericarditis and infection: documented post-operative inflammatory complications
- Haller Index rebound: studies report the chest deepening again after bar removal in a subset of patients
What surgery costs
Families are usually quoted the surgeon’s fee. The full uninsured cost of the Nuss procedure, with the hospital stay, anesthesia, follow-up and the bar removal surgery 2 to 3 years later, runs from $40,000 to $80,000. Insurance coverage varies, and denials are common when the repair is classed as cosmetic.
The bar comes out in a second surgery
After 2 to 3 years the patient goes back under general anesthesia for a second operation to remove the bar. It carries its own risks, its own recovery and its own bill.
Once the bar is out, the support it provided is gone. Studies report the chest wall deepening again after removal in a subset of patients.
Two surgeries, two anesthetics, two recoveries.
There is another way.
In the Basel cohort (about 140 patients), about 80% of studied patients improved significantly, without a single incision. Results vary. The science has existed for decades.
The FormaChest vacuum bell: what the research shows
Vacuum bell therapy was developed by Eckart Klobe, a German engineer who built the first bell in 1992 and published it with surgeons in 2005. It has about 20 years of clinical use and has been studied in 1,000+ patients across peer-reviewed research (27 studies; Sesia et al., 2025). The bell lifts the breastbone in one session, the brace keeps it there for the other 23 hours, and over months the cartilage learns the new position.
Basel cohort, about 140 patients: about 80% of studied patients improved significantly
Multiple studies report Haller Index improvement with consistent vacuum bell use, without incisions, anesthesia, or hospitalization.
Published in: Journal of Pediatric Surgery, Annals of Cardiothoracic Surgery, European Journal of Cardio-Thoracic Surgery
Commonly reported effects in studies are temporary: skin redness and mild bruising.
The full comparison
| Nuss Surgery | FormaChest Vacuum Bell |
|---|---|
| $40,000 to $80,000 | From $360, one time |
| General anesthesia + ICU recovery | Used at home. No hospital. No anesthesia. |
| Titanium bar inside chest for 2 to 3 years | External. Nothing enters the body. |
| 6-month recovery. No sports. Opioid pain management. | No hospital recovery. Used at home around school, sports and work. |
| Permanent bilateral chest scars | No incisions. Temporary skin redness or bruising is commonly reported. |
| Surgical risks, listed above | No surgical risks, because there is no surgery. |
| Second surgery required to remove bar | No hardware to remove. |
| Chest can deform again after bar removal | The bell lifts the breastbone in one session and the brace holds it; over months the cartilage learns the position. Adult cohorts take 12 to 24 months; results vary. |
| A major operation, hard on many young patients | At home. The patient controls the pressure. |
| Available only at specialized surgical centres | Ships worldwide. Start within days of ordering. |
Why it rarely comes up in a surgical consultation.
Vacuum bell therapy is not part of standard surgical training, so it is seldom raised in a consultation. It is published in the same peer-reviewed journals surgeons rely on.
Trying the bell first closes no doors. Surgery stays available if you need it.
What the published research documents
About 80% of studied patients improved significantlyBasel cohort, about 140 patients
Structured support lifted protocol adherence from 58% to 83%Haje et al. 2021, 115 patients
Try the bell first.
If it does not work, surgery is still there, and the 90-day money-back guarantee covers the bell, used bell accepted. About 80% of studied patients in the Basel cohort improved significantly, and results vary. If it works, you or your child will have avoided one of the most invasive procedures performed on otherwise healthy bodies.