Background: There are numerous body contouring surgeries that transfemales may find of benefit. The most common ones performed are liposuction, BBL and breast, buttock and hip implant surgeries which are primarily soft tissue enhancements. These are also structural body modifications (aka hard tissue procedures) that are gaining popularity which include shoulder reduction by clavicle bone removal, waist narrowing by rib removal and iliac crest plate augmentation with or without hip implants.
Just like soft tissue body contouring procedures patients often want to combine multiple structural body contouring procedures as well. While this can be done one has to be be cognizant of the recoveries involved so there is adequate after care and the patient can return home as soon as possible.
Having performed multiple site structural body modifications there are certain favorable and unfavorable combinations based on patient recovery. The general rule is that two such procedures can be combined but not three.
Case Study: This female desired the combination of shoulder reduction and waist narrowing by rib removal. She was 5’ 11” with a bideltoid distance of 52cms. She was fairly lean so liposuction was not going to make any significant waisltine reduction.
Under general anesthesia and in the prone position initially a Type 1 roib removal surgery was performed with subtotal removal of ribs #10, 11 and 12 with a lateral strip of LD muscle removal.
Once the rib removal was completed she was moved into the supine position where the shoulder reduction procedure was completed by removal of 2.6cms of clavicle bone per side.
The clavicle and rib bone and LD muscle made for an impressive amount of removed structural specimens.
She stayed overnite in the surgery center and went back to the hotel where her partner was there.
She left for home four days after the surgery with a postoperative visit and x-ray before she left. The improvement in her shoulder shape was apparent while the waist change will take much longer to see.
Because of having brought someone to help after surgery this patient was able got undergo this combination of surgeries without an arduous and prolonged recovery away from home.
Key Points:
1) Combining shoulder reduction with rib removal waistline surgery is a not uncommon transgender body contouring combination for properly selected patients.
2) The recovery from shoulder narrowing surgery is primarily that of limitation of arm movement and not as much about pain.
3) The recovery from rib removal has more discomfort than shoulder narrowing surgery which also induces some movement restriction.
4) When #2 and #3 are put together it is most ideal that the patient brings someone with them to help in their early recovery and to return home quicker.
Dr. Barry Eppley
World-Renowned Plastic Surgeon