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Aesthetic rib removal surgery is done as the ultimate or final effort to create a narrow waistline by horizontal reduction. While effective in the properly selected patient, it is a body contouring procedure that is highly misunderstood. There are many myths or misconceptions about the procedure and it is prone to hyperbole by both patients as well as surgeons who have never actually performed the procedure.

Illustrated images to better understand the procedure comes from looking at the ribcage and abdominal anatomy with both 3D and 2D CT scans. From these images several misconceptions about rib removal can be clarified.

#1 Rib removal is really subtotal rib removal. In looking at the lengths of the lower  ribs that are always removed (#11 and #12) as well as #10 which is often removed, it is clear that there is no benefit to removing the whole rib. It is only the outer half of the rib that impacts the outer contour of the waistline. This leaves  behind over 50% of the rib length or its inner half. (the white line in the image is the typical location of the rib sectioning to remove its outer half)

#2 Outer rib removal does not leave any organs unprotected. With the inner halves or two-thirds of the rib length remaining, the kidneys remain protected. In looking at a cross-section of the abdomen it is easy to see that the kidney is closer to the spinal column and on the inner half of the abdominal wall. With the inner half of the rib remaining the protection afforded to the kidneys by the lower ribs is unaffected with its outer half removal.

#3 Rib removal is a safe procedure when done properly. While the abdominal cavity lies on the inner side of the lower ribs, careful circumferential subperiosteal dissection easily avoids entering this space. In fact, that is not the risk the surgeon thinks about in circumferentially raising the tissue off of the rib before removing it. Rather as one moves up from rib #12 the pleura of the lung may be occasionally seen behind rib #11 and much more likely at rib #10, particularly in the left side where the pleura extends down lower.

Understand the anatomy of the operation also allows other misconceptions about it to be understood such as:

I will not be able to play sports afterwards (the unprotected organ fallacy)

My spinal nerves may be injured. (the complete rib removal misconception)

I will not be able to get pregnant and carry a child normally  (not sure of the basis of this claim)

Dr. Barry Eppley

Indianapolis, Indiana

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