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Background: Waist reduction surgery is typically achieved by traditional procedures such as liposuction and tummy tucks. But for thinner patients who lack any substantial abdominal skin laxity or subcutaneous fat collections, such traditional reduction methods are not of use. Any effort at further waist reduction must be focused on deeper structures such as muscle and bone.

Probably contrary to the perception of many, rib removal surgery for waist reduction is most commonly done on the thinner patient. Some may refer to these patients as having ‘extreme’ waist reduction goals because they already have a waistline than many others would like to have. But for them an even greater reduction is desired.

One of the frequent patient questions about rib removal surgery is whether it will affect them in any way physically after the procedure. This is most manifest in a female athlete who will expose the surgical result to the most physical demands. Concerns are understandable as to whether one may be exposed to injury later or will be able to perform any physical activity like they did before surgery.

Case Study: This female athlete (physique training) with a 31” waistline wanted a smaller waistline. She had two prior liposuction procedures. Due to her weight training she had large latissimus dorsi muscles.

In the prone position flank liposuction, subtotal resection of ribs #10, 11 and 12 and a wedge latissimus dorsi muscle resection were done bilaterally.

At six weeks after her surgery, she had achieved a 4 1/2 inch circumferential waist reduction result. She was back to working out at almost her preoperative level doing yoga and weight training.

Her back scars had already healed to where they were barely perceptible.

As has been my experience in rib removal surgery for waist narrowing, no physical limitations develop after surgery. One returns to full activities by 6 to 8 weeks after surgery without restrictions. A female physique athlete like this patient demonstrates this ability to its fullest. I have seen the same in gymnasts and runners. It also speaks to the value of some wedge LD muscle resection, which is fairly thick in everyone, and exceptionally so in this case. I would not consider a 4 inch waist narrowing a  typical result and his exceptional amount was undoubtably helped by the muscle resection.

Case Highlights:

1)  Rib removal surgery in a female athlete can be done without any functional compromise afterwards.

2)  In this case a 4 1/2 waistline reduction was achieved.

3) The back scars were nearly imperceptible by 6 weeks after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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