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Background: Structural waist reduction is synonymous with rib removal surgery. It is the next and last step beyond traditional soft tissue body contouring procedures. Rib removal exerts its effects by the combination of bone mass removal and the loss of thoracoabdominal muscle attachments. This allows the waistline to fall inward. How much it does so highly depends on the overlying soft tissue thicknesses.

For this reason thin patients usually get the best results from rib removal surgery. Their thinner soft tissue cover allows the loss of structural support to be more fully seen. Such patients are also more likely to successfully access and remove rib #10. The less thick the soft tissue layer is the shorter the distance between the skin incision and the ribs is. This also makes it easier to get to the back side of rib #10 so if the parietal pleura is present it can be more safely elevated during the rib dissection.                                                                                        

Case Study: This thin female desired waist reduction through structural modifications. She was very lean and would not benefit from flank or abdominal liposuction. Her lower rib outlines were seen and rib #12 able to be palpated. (which is not common) She had significant scar concerns so a type 1 approach was planned. 

Under general anesthesia and in the prone position 3.5cm long incisions were made in the lateral oblique back lines. Through the incisions rib #12 was initially isolated and removed. It was a very small amount of bone, looking very much like a shark’s tooth.

Then working upwards ribs #11 and #10 were exposed and their outer lengths removed. At rib #10 a small parietal pleura tear occurred which was sutured back together and covered with a patch of muscle.  

After a wedge of latissimus dorsi muscle was removed beneath the incision a multilayer closure was done. No drain was used.

Her immediate intraoperative result already showed the improvement in the silhouette of her waistline.

She also had shoulder narrowing surgery (clavicle reduction osteotomies) done at the same time as her rib removals. (done thereafter in the supine position) As a result she had partial eight (bones) body bones removed. (6 rib and 2 clavicles)

It is not rare to combine these two structural body reshaping procedures with the goal of a more feminine shape. The questions is never whether they can be combined into a single surgery but whether the patient is adequately prepared for the recovery.  Such patients have to be prequalified to ensure they can both physically endure the recovery as well as have the necessary support to get through it. (the latter is the most important) Given the initial limitations of the use of one’s arms having an initial support system (someone traveling with you) is important in the initial recovery after the surgery.

Case Highlights:

1) Type 1 rib removal always involves the removal of ribs #11 and #12 and #10 if it is possible. (safe)

2) Rib #10 is more important to waist reduction than rib #12 due to its larger bone mass.

3) Thin patients offer the best chance to safely remove rib #10 and keep the incision as small as possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon


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