Your Questions
Your Questions
Q: Dr. Eppley, I was reading an article by a male to female transgender woman who mentioned having a procedure in Mexico where the doctor broke her lower ribs and wrapped them tightly so that they would fuse together in a more narrow position. I am a slim young woman who would like a more narrow rib cage to give me a longer more narrow waist, but would like to keep my ribs if at all possible. I assume this would be called “rib manipulation” since it is the controlled breaking of the lower ribs. Have you heard of this being done for cosmetic purposes and can you give me information on the pros and cons of this procedure?
A: What you are referring to would be known as rib reshaping by osteotomies as opposed to the more traditional rib removal procedure to make a more narrow rib cage. The rib as it extends from the spine and around the side of the body is composed of bone (from the spine out to about halfway around the side of the body) and then becomes softer cartilage as it extends to join the sternum. (ribs 10 through 12, also known as the ‘free floaters’ do not extend to the sternum…which turns out to be a very important point in this discussion) If the rib is osteotomized (cut) at the bone-cartilage junction, the cartilaginous end would be more bendable and theoretically could be molded inward as it heals for a more narrow waistline with after surgery binding. This would only apply to the free floating ribs which do not have an attached end. It would not work for any higher ribs because they have a complete arc around the body with a fixed point to the sternum.
The advantages to rib reshaping is that it would be less invasive since the ribs are not being removed, would have an easier recovery, may be able to be be done with a smaller incision on each side and would preserve the ribs. The disadvantages is that it is not really clear if it would really work and could be a source of chronic pain if the separated rib area do not heal. (osteochondritis)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 26 year old female from who is looking to have rib removal done for ribcage narrowing. I saw online that you perform this surgery and was wondering if I would be a good candidate. My ribs have always bugged me because they protrude so much. I want them removed to create a smaller upper body and also because they stick out more than my breasts. I have attached some pictures of me laying down so you can see what I mean. I look forward to hearing from you.
A: Typically ribcage narrowing by rib removal is done to make one more ‘high-waisted’ or to lengthen the distance between the bottom of the ribcage and the hips. This is done by removing the cartilagious portions of ribs 9 and 10 which are more to the side of the ribcage. What you have/are demonstrating is rib protrusion or ribs that stick out. This involves the inner portion of the ribcage closer to the sternum rather than the side. This is a slightly different rib location. This is seen when one stands up but becomes a lot more noticeable when one lays down. (as seen in your picture) This protrusion occurs because of the confluence of ribs 6, 7 and 8. They all join in this area and the way they come together (angulation) causes them to stick out. This section of ribs can be removed (and is actually commonly done in reconstruction of microtia ears) but will require a 4 to 5 cm incision along the lower edge of the ribs to do it. This results in a fine line scar and one has to be certain that this is a good aesthetic trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in ribcage narrowing. I came to your website as I was researching a couple procedures. I am 33 year old male to female transsexual. My waistline and hip area have always bothered me. I have pretty good shape but I have always wanted curvy hips and waistline. I have spoken with many physician’s everywhere and located a couple of options for rib resection. I thoroughly enjoyed your article on ribcage narrowing. I have been studying the process and anatomy for a long time and this was a very nice description and summation. It seems as though you’ve had some hands-on experience in this procedure. I am having my breast implants replaced in a couple months. My surgeon mentioned tummy tuck at sometime in the future. I know I have a little pooch and would like that. But I really would like it by aiding access for Thoracoplasty at the same time. The other procedure is an enhancement to my nipples. I have large breast 36D but sadly I have short, flaccid & small diameter nipples and would like them to be fuller length & diameter and also perkier. Thank you once again for your time.
A: Rib resection can be done at the same time and through the same access as a tummy tuck…depending upon what type of tummy tuck is being done. In a full tummy tuck, the elevation of the upper abdominal skin flap is done right up to the subcostal margin which provides direct access to the lower rib cage. However, during a mini-tummy tuck, there is little to no elevation of the upper abdominal skin flap and the access is better done by direct incisions over the lower rib cage.
From a nipple enlargement/enhancement standpoint, the only really effective approach would be fat injections. Injecting fat can both thicken, lengthen and stiffen the nipples with a minimal risk of any loss of feeling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested to find out about a surgery known as ribcage reduction or waistline narrowing. The lower part of my ribs stick out and makes my body look funny. I would like that area to be more narrow or go in. I have heard that some of the ribs can be removed which will make for more of a tapered look. How is this surgery done and what is the recovery like?
A: Rib removal is a real operation that can be done. It specifically refers to removal of any of the ribs on the lower end of the rib cage, from 8th to the 12 th ribs. All of these ribs are largely made of cartilage with some bone on the back end of them. Usually only the cartilage portion is removed. Which cartilaginous ribs are removed is matter of what one is trying to achieve. This is not, however, a waistline narrowing procedure since the ribs do not go down that low. This is to achieve a more narrow upper trunk/abdominal region around the ribcage area. This operation is, however, fairly ‘radical’ since it will leave a small scar and is associated with a fair amount of pain afterward. Realistically it would take four to six weeks to have most of the discomfort subside.
Dr. Barry Eppley
Indianapolis, Indiana
