Rib removal surgery for aesthetic waistline narrowing can be an effective procedure in the properly selected patient. It is typically performed in my extensive experience with the procedure in women who are either seeking a more pronounced shaped waistline that what they currently have or in the transgender MTF patient who is trying create some semblance of curves with a existing straight body profile.
In performing rib removal surgery I learned quite early that the latissimus dorsi (LD) muscle, like the ribs, has an influence on the width of the waistline. This large flat back muscle is the largest muscle of the upper body with some of its origins located at the hip and lower ribs with an insertion way up on the arm bone. (humerus) It is also a wide muscle whose lateral border does have an effect on the appearance of the width of the waistline. Its widest point is actually at the waistline or just above it. Since it is necessary to partially transect the muscle perpendicular to its fibers to access ribs 10,11 and 12 beneath the back incision, I have always done resection of the muscle above and below the cut line rather than just suturing it back together. This reduction of LD muscle width with the rib removal collectively creates a waistline narrowing effect.
One of the questions that is frequently asked about the LD muscle modification in rib removal surgery is whether it results in muscle weakness or some limitations of arm function or strength. The answer is that it does not and that lack of any negative muscular effects is best illustrated by the results of the procedure done in a female body builder. This would be the definitive test in a patient in which the LD muscle is both important in function and appearance.
While the segment of LD muscle removed has good consequences for waistline width reduction, it is not large enough to affect the overall function of such a large muscle. Its percent removal by comparison is small and the longitudinal orientation of the remaining muscle fibers is maintained. This can be no better illustrated than in body builder where the lats have major importance bot aesthetically and functionally.
Dr. Barry Eppley