How Does Rib Removal Surgery Work?

Q: Dr. Eppley, I’ve been a clandestine fan of your practice; you’ve been quite innovative. Congrats. 

I have a question about rib resection, something I have no experience with or have thought about much. I just don’t get it, one can make the case that the floating ribs don’t have much effect on the waist (except maybe some for girdlers), and even might confine it by keeping soft tissues from expanding . In any event why do they need resecting, why not just remove a chunk of proximal rib and let the distal end truly float. I read on your Instagram feed that you remove some muscle, how much effect do you think that has? 

A: Thank you for your thoughtful questions about rib resection and in answer to them:

1) Ribs do make a contribution in waist girth, just not in the way that it is commonly perceived. It comes down to their soft tissue support that they provide. It is really about weakening the framework that supports the enveloping soft tissues.

2) When it comes to the floating ribs (11 and 12), 11 is by far more important…and I would argue that 12 is completely irrelevant as it is slmply too short and ‘hidden’ except in exceptionally thin females.

3) The false rib #10 makes an equal contribution as #11 which is why 10 and11 subtotal resection are the keys to the procedure. (12 is usually just taken as a ‘convenience’ and in the spirit of making a maximum surgical effort)

4) How the arc of the rib is weakened doesn’t really matter. Whether that is a distal resection, a segmental mid-resection or a proximal resection. (the latter two being collapse techniques) What does matter, of course, is the surgical risk in doing so. The proximal resection would have the higher risk being closer to the spine and is the hardest to get to being covered by the erecti spinae muscle. Distal resection is the easiest to perform through one very small incision and has a negligble morbidity in doing so.

5) The LD muscle is the largest soft tissue contributor as is incredibly thick even in small females. (1 to 3 cms) Because it has to be transgressed to perform the rib resection I have learned and observed that removing a longitudinal portion of the muscle is helpful in the overall objective with no loss of function.

6) In my experience it is the combination of structural support reduction (rib removal) and soft tissue resection (muscle excision) that creates the result. Thus the term ‘rib removal’ doesn’t really accurately describe what is actually done.

Dr. Barry Eppley

Indianapolis, Indiana