Q: Dr. Eppley, I am interested in removal surgery. I was born with pectus excavatum and significant rib protrusion. I have been advised by a thoracic surgeon that the worst ribs are 7-9. The deformities seem to be limiting my lung expansion. My insurance will cover cosmetic procedures to correct congenital deformities, as well as, medically necessary procedures for respiratory issues. I have seen you write about providing a rib resection procedure for narrowing the appearance of one’s waistline. The thoracic surgeon indicated that there is a procedure for removing the ribs while leaving the lining intact so that new ribs can form hopefully more normally (sometimes requiring bracing). I would prefer to have a plastic surgeon do such a procedure to increase the likelihood of having a more aesthetically pleasing result. Therefore, my question is: Do you have experience with any rib removal procedures that would allow for rib regeneration, and if not, do you know of any other plastic surgeon that may?
A: Rib removal in an adult is a permament procedure. As an adult, ribs that are removed whether they be the bone or cartilaginous portion, will not regenerate. That ability is lost when one is older than one year of age. So your thoracic surgeon is either misinformed or you may not have understood fully what he/she was saying. More likely the thoracic surgeon was referring to rib reshaping. The proper treatment for a pectus excavatum deformity in an adult is known as a Nuss procedure. This is where a rigid bar is placed under the ribcage to push it outward and allow for expansion and some rib recontouring. For rib protrusions of the anterior subcostal margin (ribs 7 through 9) the cartilaginous portions of the ribs can be removed to lessen the visible portion. This will improve their appearance but will not provide any improvement in pulmonary function. Only a Nuss procedure can do that. Rib removal is a cosmetic procedure not a functional one. Loss of thoracic support from rib removal can not contribute to improved pulmonary function.
Dr. Barry Eppley