How Successful Is Ribcage Modification Surgery?

Q: Dr. Eppley, Thank you for he detailed information on rib modification available on your website — it has been helpful in understanding the evolution of the procedure.

Before proceeding with imaging and formal planning, I would appreciate clarification on a few points so I can compare options responsibly:

• Approximately how many aesthetic rib contouring procedures (subcostal rib reduction) have you performed to date, and for how many years have you been performing them?
• Do you have additional before-and-after examples of subcostal rib reduction cases you are able to share?

Since my case would likely involve simultaneous breast implant exchange, I would also appreciate clarification on:

• How many combined rib contour + implant exchange procedures you have performed
• Whether you personally manage the breast revision component or collaborate with a breast specialist
• Any before-and-after examples of combined cases, if available

For surgery to feel worthwhile to me, I would be seeking a substantial and clearly visible reduction in projection. Ideally, I would hope for complete flattening of the area; at minimum, I would consider approximately a 50% reduction necessary for the trade-offs of surgery to make sense.

I understand that each case is unique and that a 3D CT scan would be necessary for final planning. I simply want to ensure my expectations align with what is safely achievable before moving forward.

Thank you again for your time and guidance.

A:In answer to your questions I can make the following comments:

1) I have an enormous ribcage modification surgical experience beginning over 15 years ago, most of which has been excisional in technique. Only more recently has the less invasive techniques become more popular although I am very reserved about them given the more limited results that I have seen from them.

2) With this vast experience in hundreds of patients the one thing I know for certain is that surgical results from ribcage modification are highly variable. Some patients get very modest results while others are more dramatic. And these are not all completely predictable. Thus the best patients for these procedures are those who see it as a structural operation in which this is all that can be done and they are willing to accept whatever result can be achieved, unpredictable as it may be. While I can certainly appreciate and respect the patient who is seeking a numerical or percentage result these types of patients make me apprehensive for taking them on due to the unpredictable success of the surgery despite how well the operation may be performed.

3) It is not rare for a combination of breast augmentation/implant exchange and ribcage modification procedures to be done during the same surgery. I often view that as beneficial due the diametric nature of the two surgeries. The one procedure helps make the other one look even better than if it was just done alone.

Dr. Barry Eppley

Plastic Surgeon