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The clavicle reduction procedure is the only method to reduce the width of the shoulders. It is most effective at ‘desquaring’ or softening the shape of the shoulders. While the removal of a segment of the clavicle bone is a straightforward concept surgically, executing it and getting the bone segments together with plate and screw fixation is challenging through such a small skin incision.

While plate and screw fixation is essential for bone healing across the two clavicle ends, it has served its purpose by 8 weeks or so after the surgery. Thereafter it is an implant that serves no purpose. But removal of the hardware secondarily is not necessary unless it causes symptoms of either discomfort or visibility. Either one will take at least 3 to 4 months to know for sure. As whether the discomfort will pass with further surgical healing or to see the full effects of soft tissue shrinkage around the titanium hardware takes time to reveal whether hardware visibility will occur.

Removal of clavicle hardware, if the patient requests, can be safely done anytime four months or more after the surgery. The removal is done through the same incision used to initially perform the surgery. Usually the scar is fairly acceptable in appearance but if it has some hypertrophy or widening this would be the time to revise it. In removing the hardware there are going to be some expected observation. While being fixation hardware it is an implant so there will be a scar capsule enveloping the hardware including between the implant and the bone on its underside. Bone growth will be seen from the residual holes top into the threads of the removed screws. The original osteotomy line, which will be well healed, is usually not seen but that depends on how far after the osteotomy surgery the removal is done. The  scar capsule, holes in the bone and the irregular bony surface contour around the hardware will eventually heal over as the final bone remodeling occurs.

While the goal of the original shoulder narrowing surgery is not to need a second surgery for hardware removal, it is sometimes needed. Fortunately, unlike the original surgery, there are no arm range of motion restrictions afterwards.       

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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