Background: Rib removal surgery has been done so infrequently that it is a highly misunderstood cosmetic body contouring procedure. While it sounds extreme, and it is certainly for the most motivated, it is neither a dangerous or a radical operation. It is a procedure that is based on an understanding of the lower shape of the ribcage.
The concept behind most rib removal surgeries is to create a more narrow waistline that has an hourglass shape. This is possible when one looks at the anatomy of the lower ribcage. The lower two ribs, known as free floating 11and 12 ribs, are not attached to any ribs above them. In fact careful inspection of their shape shows that they actually point downward more than the ribs above which assume a more horizontal orientation as they wrap around the side of the body. These more vertically oriented ribs point down toward the hip and cross the horizontal level of the anatomic waistline at the level of the umbilicus.
For those women who seek a much more narrow anatomic waistline, these lower two ribs can serve as a vertical physical block for that effect to occur. This can be demonstrated by pushing it at the side of the waistline and feeling the bony obstruction.
Case Study: This young transgender male to female patient wanted a more feminine waistline rather than the torso of a male which is more straight up and down at the sides. She also wanted to improve the hip indentations by fat injections at the same time.
Under general anesthesia and initially in the supine position the full abdomen and waistline areas in the back were harvested of fat. Then in the prone position, the flanks and upper intergluteal area were also harvested of fat. After concentration of the fat, a total of 200cc was injected into the hip indents. Then through a 4 cm incision oriented over rib #11 that did not come further to the side that the posterior axillary line, the ends of ribs 10, 11 and 12 were removed.
When viewed from behind the combination of rib removals, liposuction and fat injections to the hips made for a more hourglass torso shape. This effect will become greater over time as the waistline reduces as the swelling subsides and the tissues shrink inward.
Rib removal surgery for waistline narrowing is a bit of a misnomer. It should be called ribcage modification by removing of smaller portions of the obstructing ribs. While the pleura of the lung can be found at the level of ribs 10 and 11, careful technique can avoid its violation.
Highlights:
1) Posterior rib removals are for helping create a more narrow anatomic waistline.
2) The removal of the outer or distal portions of ribs 10, 11 and 12 removes the anatomic obstruction to the outer waistline profile
3) Rib removal is best thought of as ribcage modification as complete rib removal is never actually done.
Dr. Barry Eppley
Indianapolis, Indiana