Rib Removal vs Rib Xcar for Waist Narrowing Case Study

Introduction

Waistline narrowing can be accomplished by a variety of well known soft tissue procedures. Liposuction and tummy tucks (abdominoplasty) are the two main surgical procedures  used with emphasis on wide fascial plication techniques to maximize the waistline narrowing effect. Rib modification, or structural waistline narrowing, is a more recent type of procedure that is far less known and practiced. They are, however, beginning to emerge as another option to maximize waistline reduction in the properly selected patient.

Surgical rib modification for waistline narrowing is divided into two types of procedures, removal (excision) and contouring (bending). They differences are:

RIB REMOVAL (Rib Resection)

A  surgical procedure where the lower “floating” ribs (usually 11 and 12,and occasionally 10) undergo subtotal removal (outer prominences). With some surgeons reduction of the outer edge of the latissimus dorsi muscle may also be done.

Benefits

• Maximal narrowing of the waist
• Structural removal of the lateral rib prominences and overlying muscle
• Permanent change to the lower ribcage
• Minimally patient dependent (limited garment use)

Disadvantages

• More Invasive surgery with the creation of small incisional scars
• Short tern drain use
• Risk of postoperative seroma(fluid collection0
• Risk of nerve pain or prolonged soreness

RIB Xcar (Minimally Invasive Rib Contouring)

A technique developed for reducing the flare of  the lower ribcage without removing ribs. Using a percutaneous technique ribs 10, 11 and 12 are partially cut by a pieziotome and fractured.

Benefits

• Less invasive with a quicker recovery for most patients.
• Good complement to other body controlling procedures

Disadvantages

• Dependent on strict patient compliance with postoperative garment wear for three months after surgery
• Increased risks of pneumothorax (due to blind cutting and fracturing of the bone)
• Not ideal for patients seeking maximal waist reduction as an isolated procedure.

Side-by-Side Comparison

Case Study

This female desired rib removal surgery for waistline reduction. She had a prior BBL surgery and also lost 40lbs afterwards….losing all injected fat into her buttocks but also maximizing any fat around her waistline. As a result any reduction of her waist would have to be from a structural standpoint. She was not concerned about scars and wanted the maximal reduction.

Under general anesthesia and in the prone position 4cm vertical curvilinear incisions were made over her lateral torso. After passing through the latissimus dorsi and posterior serratus the outer portions of ribs 12, 11 and 10 were sequentially removed.

Once the ribs were removed a long strip of latissimus dorsi muscle was removed inside its outer border to add to the waistline reduction.

The incisions were then closed without the use of drains. On the right side the incisional closure was out in the ‘open’.

Conversely on the left side the incision was placed at the edge of an existing tattoo so its healing should be largely imperceptible.

Discussion

For structural waistline  reduction the decision is which rib treatment is right for each patient. That decision is affected by numerous factors but these can largely be distilled down to the following summaries.

• If the patient needs moderate waist narrowing , wants to avoid any scarring and can be compliant with extended postoperative corset wear,  then Rib Xcar would be a good choice.
• If the patient wants the most waist reduction that can be surgically achieved, has a naturally wide rib cage that limits  waist shape, and can tolerate small torso scars then Rib Removal would be the best choice.

Key Points

1) Rib surgery for waist narrowing can be done by rib fracture bending or rib removal, each with their own advantages and disadvantages.

2) In the patient who is not scar adverse rib removal offers the maximal ribcage modification which includes bone ,cartilage and muscle.

3) Rib removal surgery requires 6 weeks or less of a waistline reshaping garment.

Barry Eppley, MD, DMD

World-Renowned Plastic Surgeon