Rib removal surgery eliminates the last anatomic ‘obstruction’ to maximal horizontal waistline reduction. The ends of the free floating ribs (#s11 and 12) and the lowest false rib (#10) provide the only skeletal support to the sides of the torso at and above the waistline area. By pushing in on the sides of the waistline the outer ends of these ribs can be easily felt in most people.
Removing these bony obstructions serve as the anatomic basis for rib removal surgery and its waistline effect. It is commonly believed that the entire rib lengths are removed but this not accurate and also unnecessary. Only enough of the rib length has to be removed to have its desired effect. This is usually their outer half as there is no purpose to carrying the bony resection all the way into the vertebral facets at the spine.
Understanding what length of the rib that needs to be removed is critical in planning the location and extent of the back incision needed to do it. Because the incision is small in length, if it is placed in the wrong location (too high to too low or too close to the spine) it will become limiting as to what ribs can be removed or how much of their length can be resected. The incision is to be located over rib #11 along a natural oblique skin crease that is seen when the patient turns their body to the side. The incision length is 5 cms and it should be halfway between the lateral border of the erector spine muscle and the outer edge of the waistline.
Placing the incision in the right location allows maximal rib removals to be done with the smallest incision possible. A subcuticular skin closure assures the best scar result. The use of drains for twenty-four hours helps minimize postoperative bruising and swelling.
Dr. Barry Eppley
Indianapolis, Indiana