Rib Removal Surgery – The 12th Rib

Rib 12 removal—also called 12th rib resection or floating rib excision—is a surgical procedure to partially or completely remove the 12th rib, the lowest rib in the rib cage. Because it does not attach to the sternum, it’s termed a floating rib.

Aesthetic / body-contouring indications

• Waistline narrowing or flank contour refinement
• Typically partial resection is used to maintain stability

What the surgery involves

• Approach: Small posterolateral incision, centered over rib 11, most natural oblique skin crease.
• Extent: partial rib resection is performed, tip removal
• Muscle handling: Muscles are split to do the resection, muscle is taken and plicated inward to improve the result
• Anesthesia: General
• Duration: Often 1–2 hours

Recovery & aftercare

• Hospital stay: Same day or overnight
• Pain control: Oral meds; discomfort decreases over 1–2 weeks
• Activity: Light activity in days; avoid heavy lifting ~4–6 weeks
• Scars: Typically small and well hidden posteriorly

Risks & considerations

• Pain or prolonged soreness
• Temporary numbness or nerve irritation
• Seroma/hematoma, infection (uncommon)
• Aesthetic benefit varies with body type and rib anatomy

Candidacy

Ideal candidates generally have:

• Can palpate the rib externally
• Clear aesthetic goals with realistic expectations
• Good overall health and stable weight

Expected Contour Change After Rib 12 Removal — Based on Anatomy

The visible contour change from 12th rib removal alone is subtle and depends heavily on your underlying anatomy.

1. Rib Length & Lateral Projection (Most Important)

• A long, laterally projecting 12th rib that pushes outward into the flank
• Expected change
• ?? Noticeable inward softening of the lower waist
• ?? Reduced “shelf” or bump at the lower rib margin
• ? No dramatic hourglass by itself

Clinical takeaway

Patients who can feel or see the rib edge in the mirror benefit the most.

2. Rib Angle (Horizontal vs Downward)

More favorable

• Rib has some horizontal angulation (less than 45 degrees) 
• Acts as a rigid support pushing soft tissue outward

Less favorable

• Rib angles steeply downward (60 degrees or greater)
• Already tucked under the waist soft tissue

Expected change

• Horizontal ribs ? clearer waist indentation
• Downward ribs ? minimal visual change

3. Waist Soft Tissue Thickness

Lean patients

• Skin + muscle drape inward once rib support is gone
• ?? Sharper waist contour
• ?? More visible change even with partial resection

Higher subcutaneous fat

• Fat layer limits inward collapse
• Change may only be visible in certain poses
• Often combined with liposuction for effect

4. Muscle Anatomy (Quadratus Lumborum & Obliques)

After rib removal:

• Muscles reattach and scar inward
• They do not collapse, but they relax medially

Result

• Smooth inward contour, not a hollow
• No functional weakness when done conservatively

5. Partial vs Complete Rib 12 Resection

Partial resection

• Removes lateral projecting tiPreserves posterior support
• ?? Natural contour change

Complete resection

• Never done for aesthetic reasons
• More technically challenging to perform

Realistic Visual Outcome

Think of rib 12 removal as:

• ? Not a corset waist
• ? Not comparable to rib 10–11 removal
• ?? A refinement procedure
• Rarely ever done as the only rib for waist contouring

Best description patients use:

“My waist looks smoother and less boxy from the back and oblique views.”

When Results Are Most Noticeable

• Rear oblique views
• Arms raised
• Athletic or fitted clothing
• Post-lipo combination cases

Summary Prediction Guide

Anatomy Feature	Expected Change
Long, palpable rib	Moderate
Short/downward rib	Minimal
Lean build	More visible
Thick flank fat	Less visible
Combined with lipo	Enhanced

Dr Barry Eppley

World-Renowned Plastic Surgeon