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:
- 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.
- 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.
- 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
- There is no chance of uncontrolled bleeding from this type of surgery.
- 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
Q: Dr. Eppley, I am interested in rib removal surgery to reduce my protruding ribcage. How risky is this procedure? What are the complications/healing time? What would the results look like? How much, on average, would this cost? What other medical issues would be affected by the surgery? Sorry so many questions! Also, I live in Idaho how do you work with out-of-state patients?
A: Rib removal is not a dangerous surgery but, like any surgery that involves rib manipulation, it does cause some considerable discomfort. This is magnified when both sides of the ribcage are operated on at the same time. The best method of postoperative pain management I have found is the use of Exparel injections as intercostal nerve blocks done during the surgery. This is a local anesthetic that lasts for 72 hours after its placement. One could expect that it would take up to month after surgery until one has fully recovered. There will be a scar for the incision needed on both sides which would be about 6 to 7 cms long. The goal of the surgery is to remove ribs number 8 and 9 to reduce the subcostal protrusion.
My practice has many patients from all over the world for various types of plastic surgery. Patients usually come in the day before the surgery to have a face to face consultation and have surgery the next day. Whether you would stay overnite in the facility depends on whether you are traveling alone or with someone. I would anticipate your stay here to be no more than 2 or 3 days after rib removal surgery before returning home.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in rib removal surgery. I have a very boxy figure and I am a model. I am looking to get more of an hour glass figure and gain more confidence in my appearance. As of now I refuse to take photos straight on because they make me look wide, but I strongly believe having those ribs removed will assist me in achieving those goals. Right now my measurements are 34C bust and then my hips are 38″ at the smallest point of my midsection I am 26″, and when my personal trainer measures me at my “real waist” it is 33″ I am 5’9 and 133lbs. I would really like to have a better figure, but with wide hips and my ribs I feel like it is difficult without the surgery. What is your professional opinion?
A: I think you who feel and know your own body better than anyone has the best perspective on what may be of benefit to an improved body shape. the question is not whether rib removal will be effective but exactly what ribs are best to remove. I would doubt that 11 and 12 are the ones as they lie too posterior and do not really wrap round the torso. Thus their removal would have no benefit to bring in the sides of the torso. More likely it is ribs 8,9 or 10. If you could send me a picture of the ribs marked on your ribcage (with a Sharpie) where you feel the greatest reduction is needed, that would be very helpful in determining the exact rib numbers to be removed for your rib removal surgery.
Dr. Barry Eppley