Rib Removal

Q: Dr. Eppley, I am interested in rib removal surgery to get rid of my lower ribcage which sticks out. I do have a few questions about the surgery.

1. I know rib removal isn’t as common of a procedure as tummy tucks or breast augmentations, how many of them have been done?

2. What are the reasonable cosmetic expectations? 

3. I’ve done some research and have read that in some patients it creates permanent pain. Is this sometimes the case? 

4. Also, is there a chance of uncontrolled bleeding from the operation? 

5. What are some common complications? 

A: Rib removal surgery can be done to be used for grafts in various facial reconstuctions (usually rhinoplasty) or for cosmetic contouring of various ribcage protrusions. The fundamental difference between these two types of rib removal are the length of ribs removed and the number and location of them. In answer to your specific questions:

  1. Ribcage contouring by rib removal is a very uncommon cosmetic procedure but i do about 3 to 3 case of it per year. I do many more rib removals for rhinoplasty and jaw reconstructive procedures.
  2. The success of rib removal for improved ribcage shape depends on the exact ribcage anamoly. How many ribs and what areas can be removed vs. what is the source of the problem, and how well these match up, determines how successful the procedure can be.
  3. I have not seen a rib removal patient who has permanent pain and this most likely relates to rib removal for chest surgery which is done differently. (and at a higher rib level since they are interested in entering the chest cavity….a goal that is the exact opposite of aesthetic ribcage reshaping)  This usually involves rib bone removal not rib cartilage removal in lower ribcage reshaping. In cosmetic rib removal or any rib graft harvest great effort is made to preserve the neurovascular bundle which runs along the bottom of each rib. Nerve injury or neuromas can be a source of chronic pain.The lack of permanent pain in aesthetic rib removal should not  be confused, however, with the fact that there is some significant pain after the procedure. I attempt to limit this immediate postsurgical pain with the injection of Exparel long acting local anesthetic into the surrounding tissues as well as intecostal nerve blocks which usually lasts about 72 hours
  4. There is no chance of uncontrolled bleeding from this type of surgery.
  5. The complications from this type of surgery are essentially aesthetic….how does the scar look and how effectively has the ribcage protrusion been eliminated.

Dr. Barry Eppley

Indianapolis, Indiana