Osteotomies of ribs 8 and 9 for aesthetic torso narrowing refer to a niche but increasingly discussed body-contouring concept aimed at reducing the lower rib cage width to create a more tapered waistline.
What ribs 8 and 9 contribute aesthetically
- Ribs 8–10 are false ribs (not directly attached to the sternum)
- Ribs 8 and 9 significantly influence:
- Lower thoracic width
- Flare of the costal margin
- “Boxy” or straight torso appearance, especially in lean patients
- In some individuals, these ribs are laterally prominent or flared, limiting waist narrowing even with fat removal, muscle etching or even subtotal removal of ribs 10, 11 and 12.
What a 8–9 rib osteotomy involves (conceptually)
- Controlled osteotomies are performed on ribs 8 and/or 9, removing 1 to 1.5cms of rib length and then brought together and secured with plate and screw fixation
- The ribs are shortened and mobilized inward rather than removed
- The goal is to:
- Reduce lateral rib flare
- Narrow the lower thoracic cage
- Enhance waist-to-hip ratio
- Often paired with: lower rib removals for maximal effective of torso narrowing
This is an advanced form of rib resection surgery which turns 6 rib removal surgery into 10 rib modification torso reshaping surgery
Indications (ideal candidates)
- Lean or athletic patients
- Prominent costal margin flare
- Minimal subcutaneous fat masking rib contour
- Patients dissatisfied with waist width despite:
- Weight loss
- Core training
- Conventional liposuction
This procedure does not benefit patients whose waist width is primarily due to:
- Visceral fat
- Wide pelvis
- Thick oblique musculature alone
Anatomical and safety considerations
- Ribs 8 and 9 are close to:
- Diaphragm attachments
- Lung pleura
- Key risks to manage:
- Pneumothorax\
- Chronic intercostal pain
- Chest wall instability if over-mobilized
- Plate instability due to thin easily fragmented cortical rib bone
For these reasons conservative resection and secure fixation matter more than maximal torso narrowing.
Aesthetic benefit vs. risk
Potential benefits
True skeletal waist narrowing- Permanent change
- Improves torso taper beyond what fat reduction and lower rib removal can achieve
- Does not increase recovery substantially over lower rib removal surgery
True skeletal waist narrowingLimitations
- Longer incision for access to fixed ribs
- Is the added aesthetic effect worth the extra effort….varies by patient
- Higher risk profile than lower rib removal alone
Current status in aesthetic surgery
- Considered an advanced torso narrowing technique whose exact benefits and long term risks, f any, are not fully known due to the limited cases performed.
- More frequently discussed in:
- Gender-affirming torso feminization
- Extreme waist-to-hip optimization cases
Dr. Barry Eppley
World-Renowned Plastic Surgeon