Rib removal provides the last surgical effort to narrowing one’s waistline. The desired location of the narrowest part of the horizontal waistline is at the level of the umbilicus. At this level the downward inclination of the free floating ribs crosses this line and provides an outward push or support. It is this anatomic reason that the removal of the outer half of these ribs allows the waistline to fall further inward.
Having done many rib removal surgeries the one consistent observation I have made is that the bottom ribs angulate downward much further than one would think. They do not exit the spine at 45 degrees but much closer to 75 degrees. They are much closer to being vertically oriented than horizontal. Understanding the angulation of the lower ribs is important when determining the location of the incision for rib removal surgery.
There are three considerations in preoperative marking of the incision, location, length, angulation. First, the incision is far out to the side on the back. This is necessary for access to the long outer lengths of the ribs. Its location also needs to be placed over rib #11 as the incisional length will only allow access to one rib above and below it.. Second, the length of the incision should not be more than 5 cms for aesthetic reasons. Lastly the angulation of the incision should be placed downward and can be determined by having the patient turn their upper body the side keeping their hips forward. This will create an obliquely oriented skin crease which will guide how the incision should be oriented. A properly oriented incision will allow it to heal as best as possible as it lies parallel to a skin tension line.
All rib removals create scars which is an aesthetic liability. But proper placement, length and location on the back allows both the surgery to be successfully performed and result in a very acceptable scar.
Dr. Barry Eppley
Indianapolis, Indiana