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Technical Strategies – Subcostal Rib Shaving

 

Most of the ribs are near circumferential bone and cartilage ‘fingers’ that provide shape to the chest and abdomen. Some of these ribs can be modified to improve the shape of the torso. In the upper abdominal region is the subcostal portion of the ribcage which is composed of the union of ribs #7 through 10 of its lower portion. This creates an arc of cartilage that is shaped like a stretch out ‘U’.

Normally the subcostal ribcage has a slightly more horizontal projection than the rest of the ribcage above it. But it can have an increased projection due to genetics, congenital deformities or injury. This can create a protrusion of the subcostal ribcage that creates an unaesthetic flare or prominence.

Reduction of subcostal rib protrusions must usually be done through a direct incisional approach to be maximally effective. I have used a tummy tuck approach which can be done if the patient needs a concomitant tummy tuck. I have also approached the subcostal ribs through an inframammary incision but this does not provide good access for optimal rib reduction. The direct incision allows the rectus muscle to be vertically split and the ribs easily exposed.

Unlike posterior rib removal (#s 10, 11 and 12) where the removed ribs are done in a full thickness manner, subcostal rib modifications are often done in a reduction technique and not a removal technique per se. The protrusions can be reduced by a subcostal rib shaving technique. This can be done with a scalpel for the softer cartilaginous portions and a high-speed handpiece and burr for the more ossified cartilage portions or actual bone. The ribs can be shaved down to where there is only a thin layer left protecting the intercostal neurovascular bundle and the pleura underneath should it be located this low on the ribcage.

Subcostal rib shaving also prevents blunt ends of the remaining rib from being seen on the outside should a total resection be done. This is of particular relevance in thinner patients where there is little soft tissue cover. Rib shaving ensures that there remains a smooth shape to the reduced subcostal protrusion. Shaving may seem like it does not remove much rib but when the pieces are put together the amount of rib removed looks more substantial.

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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