Rib removal in my practice is a common body contouring procedure to improve the shape of the waistline. It is the final possible procedure for those patients who have been through prior surgical efforts (BBL,liposuction, tummy tucks) or for those who are so lean that these standard surgical procedures are not of much value. Reducing the lateral support of the abdominal musculature through free floating rib removal allows the waistline to collapse forward inward.
But there is another support to the outer waistline that is less frequently discussed that can also be beneficial for waistline narrowing. And that is the latissimus dorsi (LD) muscle. Known as the lats it covers almost all of the rest of the back muscles with the exception of the trapezius muscle high up on the back. Hence it is an extrinsic superficial back muscle. It has broad origins from the lower vertebrae (7 through 12), along the posterior iliac crest as well as the costal margins of ribs 9 through 12. This broad muscle mass converges superiorly until it inserts onto the upper humerus/arm bone. Like many muscles it has a broad base that converges to a much more narrow insertion area in a triangular-like shape.
As the LD muscle covers the entire lower back it extends out further than that of the lower ribs and their immediately surrounding muscles. This means that the width of the waistline is also supported by the thickness of the LD muscle…as much if not more so than that of the ribs. While loss of the outer protrusions of the floating ribs will make even the LD muscle moves a little inward it will not be as significant as if some LD muscle removal as well. This is the anatomic basis for the wedge muscle removal that I do in all rib removal surgeries.
Compared to the size of the muscle the wedge removal is comparatively small and has no adverse effects on its function. (abduction and internal rotation of the arm around the shoulder joint) Neither everyday or exercise limitations have been seen with this wedge muscle removal technique. A coincidental intraoperative benefit is that the muscle removal, which is done after the skin incision allows for improved visibility to do the removal of the rib sections.
Dr. Barry Eppley
World-Renowned Plastic Surgeon