Shoulder narrowing is now an established feminine body contouring surgery. It is conceptually straightforward in that a specific length of the clavicle bone is removed which brings the outer width of the shoulders in as well.
While the concept is simple, its execution is not. Since this is an aesthetic surgery a small incision is necessary to minimize the scar in a fairly conspicuous lower neck region. Working inside a 3.5cm long incision to cut the bone and then put it back together in a shortened length is challenging.
The most challenging part of the operation in my experience is bringing the shortened outer segment of the clavicle, which is attached to the shoulder, inward into the desired position. Getting the two ends of the bone together in good alignment, holding it and then securing that alignment with plates and screws requires a good assistant and sometimes more than four hands.
A technique that I find useful is partial pre plate placement. Once the bone is circumferentially isolated in a subperiosteal plane, the two bone cuts at the length of the bone are partially made with a reciprocating saw. They are made almost the whole way through the bone but not enough to destabilize the clavicle.
The medial end of the superior plate is then applied with a single bicortical screw near the osteotomy line. This holes the plate in good position but still allows the plate to rotated around the single screw for alignment on both ends of the bone when they are put back together. The two osteotomy cuts are completed and the bone segment removed. The outer bone segment is then brought into alignment with the inner bone segment by lifting the shoulder inward to help hold it into position. The superior plate is aligned and a bicortical screw placed through the plate hole near the osteotomy line. This stabilizes the bony alignment whereafter the remaining bicortical screws are placed in the plate. Lastly, a smaller anterior plate is applied for additional dimensional stability.
Establishing a plate position before the osteotomy cuts are completed establishes a fixed plate position on the most stable inner side of the bone. This makes it easier to bring in the outer bone segment once it becomes mobile and fix the plate to it….when doing these maneuvers through a small incision.
Dr. Barry Eppley