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Rib removal surgery is an aesthetic body contouring procedure that aims to narrow the waistline. It is the final option when conventional body contouring approaches have already been done or the patient is not a candidate for them. In the original technique (now known as type 1 rib removal) it was done for specifically for waistline narrowing through a small oblique back incision. Through this incision the outer portions of rib #11 and #12 were removed along with a wedge of latissimus dorsi muscle. If possible rib #10 was treated as well but was not always assured due to the incisional access.

While the focus in rib removal is understandably on the bone I learned from the very first case that the latissimus dorsi muscle also has a role to play in the width of the waistline. This is clear anatomically as the outer border of the muscle extends way past that of the lower ribs. As a result a  wedge removal of it has always been incorporated into the procedure.

Rib removal surgery has evolved over the years and has become more extensive based on patient needs. To create a greater torso narrowing effect type 2 rib removal has been devised. In this modification rib #10 is wklwats removed and rib #9 is thinne . But equally of not more important a much long vertical strip of muscle is removed. This is all possible because the incision’s orientation is changes to a curvy vertical line closer to the outer edge of the muscle.

In this approach a very long length of thick muscle can be removed. It is no longer a limited wedge but a vertical strip. Once removed by electrocautery the new edge of the muscle is seen down to the posterior serrates muscle underneath which the ribs have been removed.

Skin closure is then done over a drain that exists through the small incision though which the initial flank liposuction was performed.

Type 2 rib removal tends to be more commonly used in the transfemale patient where a greater torso narrowing effect is desired. There is no loss of function with the muscle removal. In terms of volume removal it can be seen that the muscle mass is equal to the amounts of ribs #10, #11 and #12 removal.   

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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