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Subcostal Rib Removal Through a Tummy Tuck Approach

 

The ribs constitute the structural support for the trunk. It plays a vital role in how the lungs work and in the support and protection of many other vital organs. This statement applies to much of the upper ribcage but does not necessarily apply to every aspect of every rib throughout their full lengths around the chest and abdomen. As such, there is some latitude to remove or reduce selective rib areas for body contouring effects.

Rib removal, or what I prefer to call ribcage modification surgery, is most commonly associated with waistline reduction. This is specifically horizontal waistline reduction. This is accomplished by removal of the outer half of the posterior ribs 11 and 12 and sometimes part of rib 10 as well. But this is not the only rib area which can be modified.

On the front or anterior surface is the subcostal portion of the ribcage. This rib area is distinctly different from that of the back for reasons that are different than just body location alone. The subcostal rib cage is cartilaginous and not bony. It can cause aesthetic distraction by either having too much protrusion due to a bowing of the ribs or sits low causing a short vertical waistline. Like the lower ribs on the back, subcostal rib removal can also be done to reduce a bulge in the upper abdomen/lower chest wall or to vertically lengthen the waistline.

Subcostal rib removal can be done through either a direct incision over them or from below through a tummy tuck incision. Each approach has its own advantages and disadvantages. The direct incision, even though relatively small, still leaves a scar in a non-hidden area. It limits the zone of tissue trauma by dissecting directly down to it. But it remains for the highly motivated patient.

The other approach to subcostal rib reduction is through a tummy tuck incision. In theory this should be reserved for patients that are already having or want abdominal work…but this does not need to be the case. It can be done in patients who do not necessarily need a tummy tuck as a longer lower abdominal scar may be preferable to two smaller subcostal scars. The distance to the subcostal ribs is easier to access when a full tummy tuck is performed as the upper edge of the abdominal skin flap is closer to the target than when no lower abdominal tissue is removed.

Since the subcostal ribs are cartilage and not bone, they do not have to always be excised completely. They can be shaved down with a large scalp blade for reductions in their protrusions. The ribs can be made quite thin by sequential shaving reductions where they also become more flexible/weaker which has an additional effect on protrusion reduction.

Subcostal rib reduction is more challenging than posterior rib reduction due to scar considerations from the incisional access. Both the direct and tummy tuck approaches can be used to perform it. The effectiveness of either approach in reducing subcostal protrusions is the same.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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