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Narrowing the waistline through surgery is most commonly done by two procedures. Liposuction works best when there is excessive fat such as having muffin tops or love handles. A tummy tuck can have a horizontal waistline effect but it is an operation whose tissue is greatest in the vertical not the horizontal direction.

But without excessive fat or loose skin, there are no other traditional surgeries for waistline improvement. Enter the concept of rib removal surgery. Once and perhaps still perceived as an urban myth, rib removal is a real operation that can be effective in narrowing the waistline in properly selected patients.

The anatomic basis of a skeletal reduction approach is that the outer flare of the lower ribs helps support the width of the waistline soft tissues. This can be appreciated if one pushes in at their waistline at the level of the umbilicus. You can feel the ends of the lower ribs which is likely that of the 11th free floating rib. By removing the ends of these lower ribs, the waistline soft tissues collapse or fall inward.

But rib removal is not removal of the entire rib as there is no benefit to doing so. Removal all the way back to the vertebral facets of the spine removes an unnecessary amount of rib bone. What counts is the outer half of the rib which is what provides waistline soft tissue support. Subtotal rib removal also allows the number of ribs removed (two or three) to be done through the smallest possible skin incision on the back.

One of the myths of rib removal is that it is a dangerous surgery…which it is not. Higher up on the ribcage one has to be aware of the pleural lining of the lungs on the other side of the rib. But this is not an issue at ribs 11 an 12 and comes into play at rib #10.

Dr. Barry Eppley

Indianapolis, Indiana

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