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Background: Tapering the waistline for a more inward or shapely definition can be accomplished in many patients with conventional surgical techniques. Liposuction and tummy tucks work by provide a soft tissue deflation and inward pull that works for most patients. But for those patients that seek a more dramatic change or are unresponsive to conventional body contouring efforts, rib removal surgery offers the most aggressive and last available technique.

Of the types of patients that present for rib removal, the transgender male to female is a common one. With a straight body profile from chest to hips, it is hard to work against genetics with liposuction or even a tummy tuck if needed. The more outward flare of the ribcage and wider and stiffer bony ribs and the thicker overlying latissimus dorsi muscle pose challenges  for conventional soft tissue contouring techniques.

Rib removal works by removing the last anatomic barrier for waistline contouring. Removing the outer half of the lower ribs allows the soft tissues to collapse more inward. But rib ‘reduction’ alone is not all that can be done during this procedure. I almost always treat the flank fat with liposuction as well as remove a wedge of the latissimus dorsi muscle overlying the ribs to create the most inward waistline change that is possible. This is particularly relevant in the transgender male to female patient with a thicker and broader waistline shape.

Case Study: This transgender female desired a more shapely waistline with some inward curve to it. Her preoperative markings included a circumferential waistline mark at the level of the umbilicus, lower vertebrae (midline circles), a v-shaped  wedge mark on each side of the waistline with the meridian of it being the circumferential waistline mark (green lines) and the 5 cm oblique skin incision centered over the lateral aspect of rib #11.

Under general anesthesia and in the prone position, flank liposuction was initialed performed between the wedge markings. Then the outer aspect of ribs #10, 11 and 12 were removed through the 5 cm skin incisions with separate entrances through the posterior serratus muscle. Separating the ribs proximally and then dissecting them out distally allows a long rib to be removed through such a small skin incision. A wedge of latissimus dorsi muscle was also removed of its outer half between the rib removals.

Rib Removal Surgery for Waistline Reduction Dr Barry Eppley IndianapoliusRib removal is an effective and safe procedure for those motivated patients the seek maximal waistline reduction and shape. Its name, rib removal, both belies what it actually done in its entirety as well as what portions of the rubs are actually removed.

Case Highlights:

1) Rib removal removes the last anatomic ‘obstruction’ for waistline narrowing/reduction.

2) A wedge approach is used to remove fat, muscle and rib bones to taper the waistline.

3) Transgender male to female patients are common rib removal patients that seek to provide some contouring to a body profile hat is often straight with wider flared ribs.

Dr. Barry Eppley

Indianapolis, Indiana

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