Rib 11–12 (Type 1) vs Rib 10–12 (Type 2) Resection in Advanced Waist Contouring

Rib 11–12 vs Rib 10–12 Resection

Advanced Waist Contouring — Indications, Impact, and Risk Escalation

This comparison applies to advanced, carefully selected aesthetic cases. Rib 10 involvement changes the operation from flank refinement to structural waist narrowing.

1. Anatomical Importance

Ribs 11–12

• Both are floating ribs
• Influence the lower third of the waist
• No role in chest wall stability

Effect zone

• Lower flank
• Back and rear oblique views

Ribs 10–12

• Rib 10 is a false rib loosely attached to the costal margin via cartilage
• Major contributor to true waist width along with rib 11
• Still has a significant downward inclination but turns horizontally at its anterior costal attachment
• Functionally integrated with:
  • External oblique
  • Costal margin stability
  • Upper abdominal wall

Effect zone

• Entire waist cylinder
• Frontal, oblique, and back views

2. Visual Contour Difference

Key distinction

• Rib 11–12 reshapes the lower waist
• Rib 10–12 reshapes the rib cage itself

3. Surgical Complexity & Risk

Rib 11–12 (Type 1) 

• Posterolateral or wavy vertical incisional approach
• LD muscle-splitting for access
• Low risk of encountering lung pleura

Rib 10–12 (Type 2)

• Wider thicker rib
• Is more stiff once mobilized due to the anterior subcostal attachments
• Higher likelihood of encountering the lung pleura on the backside of the rib
• Can be treated by three different methods: partial resection (out to anterior costal attachment), limited resection (bridge collapse technique) and segmental resection and shortening with plate fixation
• Allows for greater latissimus dorsi muscle resection/plication

4. Functional Considerations

11–12

• No measurable impact on respiration
• Oblique strength preserved

10–12

• Temporary reduction in core comfort
• Long-term function typically normal

5. Patient Selection (Critical)

Appropriate for Rib 11–12

• Boxy lower waist
• Long floating ribs
• First-time rib contouring
• Patient interested in more ‘limited’ surgery

Appropriate for Rib 10–12

• Very wide or flared lower rib cage
• Short-waisted torso
• Athletic / low-BMI patients
• Interested in maximal waist reduction approach
• Revision cases with inadequate narrowing

Not ideal for rib 10–12

• Thick subcutaneous fat
• Loose skin
• Unrealistic expectations
• Desire for “corset-like” effect

6. Combination Strategy

Rib 10–12 cases almost always require:

• High-definition flank lipo
• Careful symmetry control
• Conservative bilateral planning

Lipo without rib 10 removal cannot substitute for rib cage narrowing.

7. Rib Removal Concepts

• Rib 11–12:
  “Reshaping the lower waist without changing the  rib cage.”
• Rib 10–12:
  “Actual narrowing of the lower rib cage”

Bottom-Line Rib Removal Surgical Philosophy

• 11–12 = Advanced refinement
• 10–12 = Improved results more structural reconfiguration

Rib 10 can be treated with multiple techniques of which the most superior  effect on waist/torso reshaping is not yet clear. The newer technique of rib shortening by segmental resection and plate fixation pulls its costal attachments more inward.

Dr. Barry Eppley

World-Renowned Plastic Surgeon