What Type of Rib Procedure Do I Need When Scoliosis Exists?

Q: Dr. Eppley, My question is about ribxcar vs rib removal with the Latismus Dorsi muscle resection you do. I have scoliosis and my left side has much more muscle while the right curve is concave giving me a great curve on the right side but straight on the left. I’m actually seeing better results from the ribxcar remodeling procedure than the actual rib removal (which is confusing to me) but I’m thinking for me the problem is actually more the muscle on the left side. I’m wondering a) how is the ribxcar remodeling procedure yielding average 3-4 in waist reduction while rib removal seems to have very minimal change? And what is the recovery like for LD muscle resection? I’m also concerned that without that muscle I’ll have back problems since that is how my body compensates for the scoliosis. And if the muscle would just grow back. I’ve attached a photo of my torso as well as an xray of my scoliosis curve for reference Thank you!!!

A:I do not know where you’re getting your information that RibXcar is more effective than Rib Removal. In almost every case that I have seen RibXcar is always done in combination with other body contouring procedures particularly tummy tucks or BBL surgery. I have yet to see a case of RibXcar, and I have seen many, where it is done in complete isolation without any other associated body contouring procedures… so it never fully known which of the procedures had the actual effect or which one of them made the greatest contribution to the outcome. Conversely Rib Removal is almost always done as an isolated procedure. Thus it is virtually impossible to compare the effectiveness of the two procedures as they are usually done under different circumstances. (one is an ancillary procedure while the other is a prinmary procedure)

That being said improving the effects of scoliosis on torso shape/symmetry is always challenging. Without a 3-D CT scan of the rib cage it is hard to know what is creating the asymmetry although it almost always a combination of rib bone and muscle. Your plain rib cage x-ray shows the asymmetry between the two lower rib cage levels so you do know that there is a bony component. Whether the muscle is making any contribution to it can only be speculated as it would really require a 3-D MRI to fully see the shape of the LD muscle on both sides. FYI LD muscle resection is not associated with any functional limitations or causing back pain.

But looking at your body picture that you sent you are exactly the type of patient RibXcar may be considered when the torso asymmetry is more modest in magnitude.  Because it leaves minimal scarring and is a less invasive operation it is not unreasonable to first try some osteotomies of the lower ribcage (10 and 11) to see if that makes an improvement. So you can see RibXcar is not really chosen because it is the most effective procedure but given the scope of the problem a less invasive effort may be more appealing to try first. Remember, however, any success with RibXcar is critically dependent on three months of strict corset wear. It is not the operation that creates the effect it is that the operation allows postoperative molding to be done which is what creates the effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon