Waist Narrowing

Waist Narrowing – Rib Removal

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

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 downward and out-ward 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 does help the waistline to collapse inward and create a smaller circumferential measurement.

While the procedure is called Rib Removal, it involves more tissue reduc-tion than the name alone implies. Flank liposuction and latissimus dorsi muscle reduc-tions 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 subcos-tal ribcage, is also removed. This is indicated for those patients who have a shorter tor-so and/or want to do maximum waistline reduction. The entire surgery is usually per-formed through twin 4cm incisions placed over rib #11 on the back.

The amount of waistline reduction, as reported by patients, averages bet ween one and three inches depending on individual body shape, weight, thick-ness of tissues

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 dis-section away from these areas. Patients report no long-term pain or any functional limi-tations once fully healed.

Another type of aesthetic rib removal addresses prominent rib protru-sions of the subcostal ribcage. These appear in the upper abdominal area below the breasts and create bulges. They can appear on both sides or only on one side, causing a visible asymmetry. Sub-costal rib removal can be done through either a direct overlying small incision or through a tummy tuck approach if such abdominal contouring is needed. When done as part of a tummy tuck, the prominent bulges are removed and a vertical waistline or torso length-ening 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 syn-drome and slipped ribs. Both share two main symptoms: site-specific pain and an au-dible clicking sound.

The costo-iliac impingement syndrome, also known as the rib tip syndrome, resulting in back and hip pain caused by the touching of the 12th rib (and occasionally the 11th rib) against the hip bone. 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 flooring 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.

Dr. Eppley’s clinical experience in aesthetic rib removal surgery for waistline reduction 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 of waistline reduction that cannot otherwise be achieved by other means. Contact us for more information.