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An adjunctive surgical procedure to liposuction and abdominal muscle plication for decreasing waistline circumference is rib removal surgery. Practiced by few surgeons around the world it is most traditionally perceived as removal of the floating ribs. (#s 11 and 12) The concept is that these lower ribs, which do not wrap attached the torso and attach to any ribs above it,  angle downward and help support the width of the waistline through their various muscle attachments. These ribs lie right at the horizontal line of the waistline which is at the level of the umbilicus in most patients. When these ribs are shorted it is anatomically sound to assume that it will help the width of the waistline to be less. 

In the March 2023 issue of the journal Plastic and Reconstructive Surgery – Global Open an article was published tin this topic entitled ‘Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio.’ In this paper the authors evaluated five (5) patients that had the floating ribs (11 and 12) removed for waistline shaping for their clinical outcomes and patient satisfaction. The means lengths of the 11th ribs averaged around 9cms in length and the mean lengths of the 12th ribs were around 6cms. The waist-hip ratio decreased from 0.78 before surgery to 0.72 after surgery, representing a near 8% reduction. No surgical complications occurred. All patients reported good satisfaction with the waistline improvement.

The question in rib removal surgery is not whether it can be done but how effective will it be based on the patient’s anatomy and waistline goals. The procedure has its best effects on patient in whom excess soft tissue around the waistline has been previously reduced if needed by either prior conventional procedures or weight loss. In other words it should be reserved as the last measure for waistline narrowing in the most motivated of patients. The authors may call this procedure Ant Waist Surgery, a catchy name for sure and typical in Asian aesthetic surgery where procedures are often named by imaging the ideal end result, but that is not the type of dramatic change that almost any patient will achieve. Their own quantitative assessment of an 8% reduction in the waist-hip ratio speaks to a good but not dramatic change.

The author’s small case series supports that rib removal surgery is safe which is always the first concern when patients hear about this type of waistline surgery. Rib removal sounds dangerous when in fact there is not much anatomy to be concerned about at the floating rib level. Having a more extensive technique to rib removal surgery in 75 patients with well over 350 ribs removed I have yet to see have any complications. The analogy that I often make is that tummy tuck surgery has far more complications than does rib removal surgery.    

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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