Rib removal is a plastic surgery procedure that is almost an urban myth. Many have heard about it but trying to find a plastic surgeon who has really done it is a bit like getting photographs of Sasquatch. This makes many wonder if rib removal for a smaller waist is for real.
Having an hourglass figure is a physical feature for some women that has been desired and pursued through the ages. The hourglass figure is defined has a having a well defined and narrow waistline with contrasting hips. The key component is the waistline and how one defines it as it is frequently confused and its location varies on different people. The waistline is not the location of the belt line or top of the pants level as is frequently perceived. This is the waistline of clothing. The natural or anatomic waistline is where the torso creases when one bends over with straight legs. It is much higher than the belt line. It is measured at the level midway between the lowest rib and the top of the hip bone. (iliac crest) This is usually at or around the level of the belly button.’
Understanding the location of the natural waistline allows one to understand how the location of the ribs can affect. For those women that have a wide lower ribcage or protruding lower ribs, the attainment of a smaller waistline may be blocked by the anatomy of the ribs. So it is true that removal of one or more of the ribs can help narrow the waistline.
In rib removal surgery, the key question is which ribs are removed to create the waistline narrowing effect. This is going to differ amongst women and needs to be determined by actual physical examination. One should feel the location of the ribs and where it relates to the anatomic waistline. Rib removal is clearly done on the lower portion of the ribcage anywhere from rib eight to twelve. Rib removal is historically described as removing the lower eleventh and twelfth ribs (floating ribs) but this is not right for everyone. These are the shortest ribs and often do not extend enough to the sides to really impact the waistline. Portions of the ninth and tenth ribs can also be considered as they wrap more around the sides. Having the patient suck in their waistline as much as possible can really help make this identification much easier.
Rb removal is without question a procedure done under general anesthesia and may require the patient to be prone or on their sides for the surgery. Intercostal nerve blocks with long-acting local anesthetics (e.g., Marcaine, Exparel) is very helpful for pain control in the first few days after surgery. Like all rib removal procedures, it can take months until one has a full recovery. Rib removal for waistline narrowing is unique over other rib removal surgeries because it is done on both sides of the ribcage. Also it requires an incision of some length to gain access to the ribs and this must be considered an aesthetic trade-off (scar) for the amount of waistline narrowing.
Rib removal for aesthetic waistline narrowing would be considered an extreme plastic surgery procedure. It should be reserved for the most motivated of patients who are willing to take relatively drastic measures for an aesthetic gain. There are also many other nonsurgical and surgical procedures that can have a positive waistline effect. Various types of garments and corsets have been well shown to be effective with regular and long-term use. Plastic surgery procedures to change the area above (breast augmentation) and below (tummy tuck) can create a more ‘narrow’ waistline perception. Liposuction that directly removes subcutaneous fat right at the waistline can also sculpt out out a more defined waistline.
Dr. Barry Eppley
Indianapolis, Indiana