Background: Rib removal surgery is commonly associated with waistline reduction through removal of portions of ribs #11 and 12. (and sometimes #10 as well) This creates a width reduction of the anatomic waistline by removing some of the lateral ribcage support which allows the soft tissue to ‘fall in’ more. This is historically and most commonly done as an end stage procedure for those highly motivated women who seek the maximum amount of waistline reduction.
But rib removal is also done for the male to female transgender patient and is a rapidly growing number of patients who seek out this procedure. It is a logical body contouring procedure because the male ribcage is larger and more developed than that in females. This makes it very difficult to have a feminine or more hourglass waistline due to the phenotypical ribcage anatomy.
But what separates transgender rib removal surgery is that often both back and front rib removals are done. This is to reduce the prominent subcostal margin and wide lower ribcage at the same time for a more feminine appearing waistline and torso.
Case Study: This 58 year-old male to female transgender patient wanted to reshape her entire abdominal/back area to make it have a less masculine appearance.
Under general anesthesia she initially underwent in the supine position full abdominal and flank liposuction and subcostal rib cage remodeling. Using a 6 cm incision, the cartilaginous portions of ribs # 8 and #9 were removed back to their bony junction. Due to her age, the ribs were partially ossified resulting in ribs #8 and #9 being removed in pieces. Rib # 7 was heavily shaved from top to bottom to reduce its protrusion.
Then in the prone position the entire back and waistline also underwent liposuction. Ribs # 10, 11 and 12 had their distal bony portions removed through a 6 cm incision to within 8 cms of their vertebral facets. The fat removed was processed and then used for buttock and hip injection augmentation.
The change in the subcostal/upper abdominal area was evident on completion of the anterior procedure both from the top and bottom angles views.
The change in the waistline and buttock size was also very evident when viewed from the top back view.
An overall change of the torso and waistline is needed in many male to female transgender patients. Ribcage modification through anterior and posterior rib removals combined with circumferential liposuction provides for a maximal treatment plan.
Highlights:
1) Anterior rib removal is to reduce subcostal protrusions and vertically lengthen the torso. This is often desired in male to female transgender patients. It is frequently combined with posterior rib removal for waistline narrowing.
2) A direct subcostal approach is usually used to remove the cartilaginous portions of ribs #7, 8 and 9.
3) Anterior rib removal is often combined with posterior rib removal for an overall waistline and torso reshaping change
Dr. Barry Eppley
Indianapolis, Indiana