Introduction
The 10th rib is one of the false ribs in the human rib cage. Humans typically have twelve pairs of ribs, numbered from top to bottom:
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Ribs 1–7 are true ribs, attaching directly to the sternum via their own costal cartilages.
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Ribs 8–10 are false ribs, whose costal cartilages connect indirectly to the sternum through the cartilage of the rib above.
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Ribs 11–12 are floating ribs, with no anterior attachment to the sternum.
Rib 10 serves as a transitional rib — the last of the false ribs to have an indirect articulation with the sternum. It originates from the 10th thoracic vertebra and has a thin, curved shaft angling forward and downward. Its anterior end connects via cartilage to the ninth rib’s cartilage, which then joins the sternum. This junction is fibrous rather than firmly cartilaginous.
Because of this relatively free anterior end, the 10th rib can sometimes be visible or palpable in thin individuals or in those with ribcage asymmetry. The cartilaginous tip may protrude below the costal margin, forming a small but noticeable bump. For patients who find this aesthetically bothersome, the rib tip can be removed through a small incision. This area is also commonly used as a donor site for cartilage grafts in rhinoplasty or ear reconstruction.
Case Study
This female patient had previously undergone rib removal surgery involving ribs 10, 11, and 12. Preoperatively, she exhibited prominent rib 10 tips, most notably on the left side due to underlying scoliosis. It was anticipated that removing rib 10 as far forward as possible via the posterior approach would cause the rib end to lose structural support and diminish its prominence. However, this did not occur. A secondary direct excision was therefore performed.
A 1.5 cm skin incision was made directly over the prominent rib tip. The rectus abdominis muscle was split vertically to access the site. The cartilaginous end of rib 10 was dissected circumferentially, freed from surrounding soft tissue attachments, transected, and removed. On the right side, the cartilage segment was straight and uniform.
In contrast, the left side was more prominent, and the rib tip was sharply curved—explaining its greater outward projection.
Comparing both rib ends demonstrated the asymmetry: the right side appeared anatomically normal, whereas the left side was deformed, consistent with the patient’s preoperative 3D ribcage scan.
Discussion
Partial resection of rib 10 may be indicated for medical or cosmetic/body-contouring purposes.
Medical Indications
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Slipped Rib Syndrome: Occurs when part of a rib cartilage moves abnormally, causing pain. Removal of the unstable segment may relieve symptoms.
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Rib–Iliac Crest Impingement: When the rib end contacts the pelvic crest, excision of the rib tip can eliminate mechanical irritation.
Cosmetic and Body-Contouring Indications
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Waistline Narrowing: Removal of outward-projecting ribs can allow for a subtle inward “collapse” of the waistline. This may be considered when non-surgical methods (e.g., diet, exercise) or traditional procedures (e.g., liposuction, abdominoplasty) fail to achieve the desired contour.
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Selective Rib Protrusions: Isolated prominence of the subcostal margin, typically ribs 9 or 10, can be corrected without extensive rib resection.
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Subcostal Rib Flare vs. Rib Tip Protrusion: Rib 10 prominence is a minor variant of subcostal protrusion, distinct from true subcostal flare, which usually involves rib 8.
A prominent rib 10 tip is most often seen in patients with ribcage asymmetry such as scoliosis. Correction is straightforward, requiring minimal access and resulting in a small, well-concealed scar.
Key Points
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Rib 10 has a freely mobile cartilaginous end that can project below the lateral subcostal margin.
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A direct, limited incision allows for removal of the rib 10 cartilage with minimal scarring.
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Previous posterior rib removal may leave behind a residual cartilaginous segment, requiring secondary excision for complete correction.
Barry Eppley, MD, DMD
World-Renowned Plastic Surgeon