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Background: While there are many bony structural procedures of the face, there are very few on the body. Those that do exist, however, are bony in nature and consist of shoulder, rib and iliac bony changes. In the transfemale patient population in particular shoulder and waist reductions are desired to help create more body contour shape. (curves) Both are bone removal procedures which are often done but individually. A frequent question then is whether clavicle reduction osteotomies and rib removal surgery can be done together.

This question is a not uncommon one and is based on recovery. Technically there is no problem performing the procedures during the same surgery as each takes about 2 1/2 hours to complete. But each one has a unique recovery and putting them together magnifies that recovery process. The most limiting in recovery of the two is the shoulder reduction procedure. There is a period of limited arm motion after shoulder reduction which will definitely create some limitations in recovery. Rib removal causes pain but there are no restrictions per se as you can’t affect the healing of tissues that have been removed.

Because of the early restricted arm movement combined with torso stiffness and discomfort it is not a recovery for the surgery in experienced or to undertake alone. The early recovery period, as defined by the time between the completion of surgery and returning back home, is made a lot more tolerable if you have help. The first night after surgery is not a problem since all patients stay overnite in the surgery center. But it is the following days when  some assistance is most ideal.

Case Study: This female desire to undergo both shoulder reduction and rib removal surgery and came from afar by herself. (not ideal but manageable) She arrived the day before the surgery and planned to stay for one week after the surgery.

Under general anesthesia and in the prone position a Type II rib removal procedure was initially performed. Ribs #10 through #12 were treated along with muscle removal. The incisions were closed over a drain.

Then back in the supine position the shoulder reduction procedure was done removing 2.5cms of bone from each clavicle.

She stayed overnight in the surgery center and was discharged rage following morning back to her hotel. (with assistance) She gradually recovered largely on her own with intermittent help. 

While aesthetically effective combining shoulder reduction with rib removal surgery creastes a challenging early recovery process. It is not an ideal body contouring surgery for the inexperienced surgical patient or one that has not arranged for assistance in the immediate postoperative period.

Key Points:

1) Shoulder and waist reduction are two of the commonly performed structural body contouring procedures.

2) Clavicle reduction osteotomies and rib removal surgery can be performed in specially selected patients. 

3) Rib removal is ibefore shoulder reeducation as a combined procedure as it requires a prone position to be performed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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