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Narrowing one’s waistline can be effectively done for most people by a variety of non-surgical and surgical methods. Dieting, exercise, liposuction and tummy tucks will fulfill the aesthetic goals of the vast majority of people who choose to do so. But for a select few patients such methods are not effective enough for their waistline goals and they seek a more aggressive approach to achieve the maximal reduction possible.

This is where rib removal surgery has a role in waistline reduction. This eliminates the last ‘obstruction’ to further inward movement of the waistline shape. By removing the outer bony support to the overlying soft tissues it allows them to collapse more inward. How effective it would be depends the person’s natural shape and thickness of tissues.

Rib removal surgery is done through a series of surgical steps that strive to remove as much of the lower free floating ribs as possible (usually #10 ribs as well) through the small possible skin incision. (six rib removal waistline reduction) It is done in the prone position under general anethesia through paired 5cm back incisions placed close to the side of the waistline. This is the smallest skin incision that is possible. Going through the fat and two muscle layers the ribs are identified and the proximal bone cut is made at the lateral border to the erector spine muscle. This allows the cut end of the rib to be pulled up and out of the incision.

The tissues are dissected off of the rib in a direction towards its cartilaginous tip with more of the rib being pulled out of the incision as it becomes more free. It continues to be mobilized in a circumferential fashion until the soft tissue attachments to the cartilaginous tip are released at which point the rib is removed. At each rib level the posterior serrates muscle is closed back over the now empty rib tunnel.

The placement of the skin incision on the back is critical. Its small size will only permit one rib to be taken above and below. Thus the importance of centering it over the 11th rib. If the preoperative markings are off, only the 11th or 12th rib may be taken (incision too low) or only the 10th and 11th rib can be taken. (incision too high)

Dr. Barry Eppley

Indianapolis, Indiana

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