Rib Removal and Vascular Malformation
Q: Dr. Eppley, I have a combination problem consisting of a venous malformation over my right ribcage and a prominent frontal bulk, which I assume is rib cartilage, in the front. My questions are;
1) Where would the scar be for the venous malformation and rib removal? Would it be in the same place (around 10th rib) as the normal method, only slightly longer? And then another incision on the front chest to reduce that bulk? Or would the incision continue in one long line from back to front? I do have partial rib removal already from a failed otoplasty when I was younger and rib graft from my front rib so already have a scar there and a dent. I hope to cut out the remaining area of this out so it isn’t a sharp dent anymore and also on the other side. I can’t wear corsets right now to try and waist train for any longer than a few hours due to the pain of this sharp dent from where the previous rib reconstruction was taken. I included a pic of the rib graft incision. Would it be ok the same place on the front?
So basically removing the back ribs as much as possible with the venous malformation and muscle and also reducing frontal ones. Would this give me a dramatic change to my waist size? You can see on the pics below how large and disproportional my ribcage looks compared to the rest of my body. I’ve always had this broadness.
A: To answer your more specific rib removal questions and to clear up some misconceptions:
1) What you refer to as ‘frontal muscle bulk’ is actually the subcostal margin of the union of the cartilaginous ribs # 6,7,8 and 9. This is all cartilage and not muscle.
2) You have had a prior left rib graft harvest in which portion of cartilaginous rib #6 was removed….which was for your otoplasty procedure. This has left you with a blunt cartilage end of #7 and the union of the ends of #8 and #9 exposed lower.
3) With your very thin body frame with little soft tissue cover over the ribs I would be concerned that any rib removal would show the remaining ends from their removals.
4) Removing the anterior subcostal rib margins creates what is known as ‘vertical waistline elongation’ as it creates more distance between the bottom of the ribs and the waistline in the front view.
5) #4 should not be confused with horizontal waistline reduction which refers to ribs #10, 11 and 12 and is done from the back with the goal of bringing in the sides of the waistline at the level of the belly button.
6) The incision for the anterior rib removals would have to be different for each side, using the existing one on the left side but a longer and more posterior one on the right side.
Dr. Barry Eppley