Background: Rib removal surgery reaches the deeper anatomic layer for waistline narrowing. It may be done as the last treatment possible for patients that have had more standard procedures such as liposuction, BBL surgery or tummy tucks and remain unsatisfied with their waistline shape. It may also be the only good option for patients that are lean and with a low body weight that have had no prior surgery.
To those patients that seek to undergo the procedure this may be the only body contouring procedure that they want. But an equal number of such patients would like other body modifications at the same time. This could be a number of other procedures from shoulder narrowing, breast implants, hip augmentation to buttock implants/lifts…to mention the major ones. When considering combining body contouring procedures the question is not whether they can be technically done together… but what impact does it have on the patient’s recovery? This consideration should not be taken lightly in any type of aesthetic body surgery. The face is very different as an almost endless number of procedures can be combined since much of the recovery will be more about aesthetic issues (facial swelling) than being functionally limited on the activities of one’s daily living like body contouring surgery does.
In my practice where every patient travels in for surgery the important considerations in body contouring surgery are: 1) are you coming alone or with someone? and 2) how are you traveling to get here and from what distance? By far #1 is the most important since decreased mobility is the primary limitation. While I have done many major combined body contouring procedures in patients traveling alone, I would be more cautious in this scenario. Rib removal alone would be fine but other procedures such as shoulder reduction and buttock implants create a substantial recovery that can be very difficult and may result in a protracted stay.
Case Study: This female sought multiple body contouring procedures including shoulder reduction, rib removals, lower buttock lifts, limited inner thigh lifts and fat injections to the hips. While this was a long list of body contouring procedures the major for recovery were the shoulders and ribs.
In surgery the first procedures done were in the prone position. The lower buttock lifts were completed by ellipitical excisions on the lower buttocks of a wedge of skin and fat. The dermal edges were sewn down to the gluteal fascia to create new raised infragluteal folds. Thee rib removals were completed next through a combination of flank liposuction, removal of the outer half of ribs #11 and #12 and a wedge resection of the latissimus dorsi muscle. The fat from the flank liposuction was injected into the hips. (50cc per side)
Then in the prone position the shoulders were reshaped by clavicle reduction osteotomies and limited horizontal thigh lifts were done keeping the closure within the groin creases.
Such a combined body contouring surgery takes almost 7 hours to complete and the patient stayed in the surgery center overnite for the immediate recovery. She went back to the hotel the next morning with her traveling companion. Her drains were removed 3 days later and she went home 5 days after the surgery.
Recovery from extensive body contouring surgeries must consider numerous variables including what procedures are being performed, what support system will be immediately available and what is the travel like for getting back home. While patients may look at the longer term aspects of the recovery, when you travel for surgery postoperative planning must take into account the immediate recovery period…which is what happens right after the surgery until one arrives back at home.
Case Highlights:
1) The combination of rib removal and shoulder reduction surgeries requires one to bring assistance with them to aid their recovery and to get home safely as soon as possible.
2) The postoperative protocol is mandatory overnight stay in the surgery center with discharge to the hotel the following morning.
3) Other more minor body contouring procedures can be added to the ribs and shoulders and do not prolong the recovery.
Dr. Barry Eppley
Indianapolis, Indiana