Background: Rib removal is a body contouring procedure for which there is much misinformation. It is a real surgical procedure that is done for numerous aesthetic reasons, one of which is reduction of the waistline. This is reduction of the anatomic waistline which is located at the level of the belly button and not that of the hips.
A review of the anatomy of the lower ribs reveals why their removal might be effective. Unlike the ribs that lie above, the true free floating ribs of #11 and #12 have a very downward angle to them. This downward angle combined with their long length can serve as an ‘obstruction’ if one wants to go beyond the natural waistline shape. In some people these ribs can be very long and there is little space between their ends and the iliac crest.
While the term rib removal is used, it is important to understand that it is subtotal rib removal. There is no aesthetic benefit to taking the whole rib as only the outer portion has an impact on the anatomic waistline. The ribs are only removed back to the lateral border of the erector spinae muscle. This makes the length removed of 6cm to 8cm of rib #12 and 12cm to 15cms of rib #11. These are still substantial lengths but just not the whole rib length.
Case Study: This 26 year-old female desired maximal waistline reduction. She was at a low body fat level, exercised regularly, and had a prior procedure of liposuction of her waistline and back. She also waist trained using a corset. Her current circumferential waistline measurement was 26 inches.
Under general anesthesia and in the prone position, bilateral 5 cm skin incisions were made on her low back. These incisions were marked in an oblique orientation based on a skin crease line that was created by her twisting around her waistline to the sides. Rib #11 and 12 were identified, detached from their musculature and taken back to the lateral border of the erector spinae muscle. What was impressive about these ribs was how angled downward and long they were. At the midportion of rib #11 the pleura of the lung was visualized in one area. Rib #10 was treated by removing a several cm portion of the lateral aspect of the rib to allow it to collapse inward.
When finished with one side of rib removal/modification it could be seen how much the waistline on that side collapsed inward.
Rib removal for waistline reduction is usually done on very motivated women that seek maximal waistline narrowing. They have done numerous maneuvers to reduce their waistline and are seeking rib removal as the last stop on this body contouring journey. They often have previously pursued fat reduction efforts through liposuction and have done or are currently doing corset waistline training.
Highlights:
1) Maximal waistline reduction can be achieved by removal of the outer portions of the true free floating ribs
2) A subtotal ostectomy of rib #10 (arc reduction) can also be helpful for reducing its circumference around the waistline.
3) Rib removal for anatomic waistline reduction is a safe and effective procedure.
Dr. Barry Eppley
Indianapolis, Indiana