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Rib removal is a surgery that is performed as the last effort to maximize waistline narrowing. It is associated with what its name implies, rib removal, and is commonly believed that this is all that is done ding the surgery. But rib removal surgery is actually a collection of procedures which treat all tissues elements that stand between the existing side of the waistline and the most inward movement that is possible.

The first tissue that can always be removed is fat at the flank area and directly at the lateral waistline area. (circumferential line drawn around the umbilicus as the meridian of the flank region) Many rib removal patients have had prior liposuction for waistline reduction either as a stand alone procedure or from having a BBL procedure. Despite having had previous liposuction there is always some more fat to harvest.

The flank area is marked in the standing position before surgery and it usually is over the 12th rib location and lower. One always go up higher over ribs 11 and 12 as well.

From the prone position, which is necessary for rib removal of #10, 11 and 12, this is an ideal position to cut the waistline as much as possible with liposuction. The liposuction entrance sites can also serve as the exit site of drains if they are to be used. A 3 or 4mm basket cannula is used. The goal is to create a visible indentation along the waistline. While liposuction is usually done to create a smooth even surface, this is one of the few times where the goal is to create a contour ‘deformity’. (indentation)

The amount of fat extracted is usually in the 50ccc to100cc aspirate amount per side. But if the patient has never had prior liposuction that amount may well be in the 200cc to 300cc aspirate range. While this is never a large amount of fat, particularly after concentration, it is never wasted and  be recycled and injected wherever the patient wants.

Flank liposuction adds a small but significant enhancement to the waistline reduction effort in rib removal surgery. There is never a reason to not do it and every little bit of additive reduction has value to the patient who makes the commitment to undergo rib removal surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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