How Can My Subcostal Rib Protrusion Be Reduced?

Q: Dr. Eppley, I need your opinion on what would help me best (even if you won’t perform it) on a rib procedure I am looking to get done. I’ve read so much about you and am just really amazed at the unique work you do and the number of lives you’ve changed. anyway here is my issue. I was born an identical quadruplet, and as a result I was given some congential problems that has destroyed my confidence in my body. So I have assymetrical ribs. And by this I mean there is a thinner side (the right) and a thicker, protruding side which is the left (this is also reflected in my chest wall, my left pec easily grows thick while my right does not). My problem is, not only is it very unappealing, but as I work my abdominals, the thicker side gets all the work and those abs get overdeveloped. What am I wondering is what would be the best way to get the thicker side rib cage in the subcostal region (where the upper abdominals are shaped) to match the thinner, flat side, so my abs can be at a symmetrical level and my stomach be more symmetrical and thinner. I’ve attached a few photos as an example. I am a very motivated patient, and would do anything to get the left ribs to be flatter and as thin as the right. What would you suggest I tell a qualified surgeon to do? I really really appreciate you and all the knowledge i’ve gotten from you and read on your site. You give me hope that my body won’t always be a point of such deep frustration. Thank you. 

A; Thank you for your inquiry and sending your pictures. What you have is an ipsilateral protrusion of the right subcostal cartilaginous ribcage. It is probably not that the subcostal ribs are ‘thicker’ but the arc or curve of the ribs is greater than that of the opposite side. A 3D CT scan of your ribcage would confirm the exact anatomic anomaly.

The question is not whether this subcostal rib protusion can be reduced, as it can, but how to do so with the least amount of scarring as possible. Such subcostal rib protrusions are reduced, usually by shaving, through direct incisional access with an incisional length of 3 to 4 cms.

Dr. Barry Eppley

Indianapolis, Indiana