Waist Narrowing

Waist Narrowing

Waist Narrowing – commonly called Rib Removal Surgery – is a body contouring procedure for reduction of internal anatomic restrictions for horizontal waistline narrowing. When non-surgical (diet, exercise and waist training) and surgical efforts (liposuction, tummy tucks) have not achieved as much waistline reduction as desired, one can consider rib removal surgery.

The concept of rib removal can be appreciated by pushing in on your own waistline in which ribs #11 and #12 can be felt. These free-floating ribs angle sharply downward, unlike all ribs above them, where their ends are attached to muscle and fascia. These ribs provide outward support to the shape of the waistline. As a result, reduction of the outer ends of these ribs can help the waistline to collapse inward and create a more inward shape and a  smaller circumferential measurement.

While the procedure is called Rib Removal, it involves more tissue reduction than the name alone implies. Flank liposuction and latissimus dorsi muscle reductions are also concurrently done to further improve the amount of waistline reduction achieved. In all patients, the outer sections of ribs #11 and #12 are removed. In certain patients, a section of rib #10, which wraps around the waistline to attach to the subcostal ribcage, is also removed. This is indicated for those patients who have a shorter torso and/or want to do maximum waistline reduction. The entire surgery is usually performed through twin 4.5cm incisions placed over rib #11 on the back.

One of the very important maneuvers in rib removal surgery is the preservation of the intercostal neurovascular bundle, specifically the intercostal nerve. You want to be able to remove the rib portion but keep the intercostal nerve, which runs along a groove on the underside of the rib, intact. By not injuring the nerve at each rib removal site the risk of chronic pain from nerve injury after surgery is eliminated.

The amount of waistline reduction, as reported by patients, averages between one and three inches depending on individual body shape, weight, and thickness of tissues. Everyone sees a more inward movement or concavity to the outer waistline which is aesthetically more valuable than a circumferential waistline measurement for most patients.

Dr. Eppley’s clinical experience in aesthetic rib removal surgery for waist narrowing is that it is extremely safe and presents no long-term issues with partial loss of the outer portions of the lower ribs or the muscle that has been removed. In the properly selected patient, it offers an amount a waist narrowing effect that cannot otherwise be achieved by more commonly used procedures.  (liposuction, tummy tuck) Rib removal surgery is often combined with other procedures such as buttock and hip augmentation, taking advantage of the prone patient position in surgery used for rib removal surgery.

A common misconception is that there is damage to internal organs during or following surgery. With ribs #12 overlying the fascia of the kidney and rib #10 close to the pleura of the lung, staying in the circumferential subperiosteal plane of the rib keeps the dissection away from these areas and makes the procedure safe. Patients report no long-term pain or any functional limitations once fully healed. Very active patients, such as gymnasts and bodybuilders, have had the procedure with full return to their strenuous activities.

Another type of aesthetic rib removal, Subcostal Rib Shaving, is done for anterior  protrusions of the subcostal ribcage. These appear in the upper abdominal area below the breasts and create bulging prominences. They can appear on both sides or only on one side, causing a visible asymmetry. Subcostal rib reduction can be done through either a direct overlying small incision or through a tummy tuck approach at the time of a tummy tuck if that is also needed. When done as part of a tummy tuck, the prominent bulges are removed and a vertical waistline or torso lengthening is created as well.

There are also medical reasons for rib removal due to chronic pain. Non-fracture rib pain conditions are generally of two types, the costo-iliac impingement syndrome and the slipped rib syndrome. Both share two main symptoms: site-specific pain and a palpable clicking sound.

The costo-iliac impingement syndrome, also known as the rib tip syndrome, results in back and hip pain caused by the touching of the 12th rib (and occasionally the 11th rib) against the top of the hip bone. (iliac crest) It most commonly occurs in patients who have had osteoporosis of the spine and loss of vertebral height. This allows the spine to curve and bend towards one side. It can also occur in patients with congenital scoliosis as well as younger patients who have naturally longer free floating ribs or an accentuated angulation to them. The slipped rib syndrome is when the cartilage on the lower rib slips or moves leading to pain. In this rib condition a mobility of the rib usually refers to ribs #8, 9 or 10 and their cartilaginous junction with the bone. The bony rib becomes disarticulated from its more anterior cartilaginous portion. (costochondral junction separation) Mobility at the bone-cartilage junction either impinges on the intercostal nerve or causes inflammation due to periosteal/perichondrial irritation. The clicking is the two ends moving against each other. Both conditions response well to removal of the offending part of the rib.