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Background: Rib removal is the final and definitive procedure for waist narrowing when the patient is seeking a result  beyond what standard body contouring surgery can achieve. The traditional rib removal surgery focuses on the bottom two or free floating ribs as they lie adjacent to the waistline and their cartilaginous tips are the point of attachment for multiple abdominal and back muscles. Thus when these muscular attachments loose their insertions the lateral support of the waistline is reduced.

The traditional or Type 1 rib removal procedure uses a small oblique lateral back incision to access the ribs and the latissimus dorsi (LD) muscle. While effective for some patients getting up to rib #10 can be challenging and the section of LS muscle that can be removed is limited. 

This has led to a different incision approach to rib removal surgery with a change in the incision orientation which allows for greater bone and muscle removal. Moving the incision to a vertical orientation provides assurance that rib #10 can be treated and a bigger longitudinal section of the muscle can be reduced.

Case Study: This female desired a waist/torso narrowing change. We discussed Type 1 vs Type 2 rib removal and she opted for the latter for maximum result. She was less concerned about the scar location differences.

Under general anesthesia and in the prone position the non-straight shape of the marked incision was made and the LD muscle exposed.

The LD muscle was split longitudinally exposed the serratus muscle over the ribs. By going through the serratus muscle rib #12 was exposed and its distal third removed.

Climbing up the ‘ladder’ ribs #11 and #10 were similarly exposed and sections of them removed. At each rib level the empty rib pocket was packed with an Exparel-soaked collagen sponge and the serrratus muscle closed over it.

Once the rib removals were complete the ‘excess’ LD muscle was longitudinally removed over the length of the rib removals and plicated down. The incisions were then closed in layers with reservable sutures.

Her intraop before and after started to show the reductive change which will take up to 3 months to fully see….aided by use of a shaper garment in the interim to help the soft tissue remodeling process. 


  1. Type 2 rib removal surgery has a vertical incision orientation which allows for improved rib access and better ‘climbing of the ladder’ up the ribcage.
  2. Rib #10 can be reduced which provides more torso reduction than just discrete waist narrowing.
  3. The split LD muscle access to the ribs allows for more rapid access and a muscle reducing excision technique as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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