The most perceived reason that rib removal surgery is performed is for narrowing of the anatomic waistline. This is done by removing portions of ribs 11and 12 and sometimes even rib #10. This operation works because it removes the outward support of the musculature that occurs from the very downward projecting terminal 11 and 12 ribs. This is done through a small oblique incision on the lower back. This is known as posterior rib removal as it is on the posterior or dorsal surface of the trunk.
But ribcage modifications for aesthetic purposes is not just limited to the posterior or lower ribs. Rib #s 7, 8 and 9 on the anterior subcostal margin of the chest can also be treated. Subcostal ribs that are too protrusive can be removed. Unlike the posterior ribs which are bony, anterior ribs are softer and cartilaginous in structure. These ribs run form the sternum out to the side where they turn into bone at their osteocartilaginous junction at the side of the chest. This is known as anterior rib removal or subcostal resections.
The access to anterior rib removal can be done through two very different incisional approaches. Like the posterior ribs a small incision over the subcostal margin can be used. (direct approach) Another option is to use a tummy tuck incision. (indirect approach) If one is having a tummy tuck anyway then this would be the obvious choice. It is a long way from the low tummy tuck incision up to the subcostal margin but it can be done without undue difficulty. The rectus muscles are split right over the subcostal edge of the ribs and they are then removed. Once could also choose the indirect approach even if they don’t need a tummy tuck but one has to accept the traditional low tummy tuck scar.
Anterior rib removals iare less known and discussed than the more well known posterior rib removals for waistline narrowing. But in my rib removal experience, there are as many requests for anterior rib removal as there is for the posterior ones. The incision chosen is based on whether they have had a prior tummy tuck or are in need of one.
Dr. Barry Eppley
Indianapolis, Indiana