is Rib Ostectomy As Good As Rib Removal In Waistline Narrowing Surgery?

Q: Dr. Eppley, I wanted your medical opinion on the potential approaches to rib removal surgery. Regarding the rib removal, we discussed the big impact of having the 10, 11, and 12 ribs resected. I would like to hear your thoughts on the following and I have included images (attached) to aid in clarification of what I am trying to ask.

1.- Latissmus muscle resection

During my consultation you mentioned you normally resects the lower part of the latissmus muscle (I show on the image as red). Would it be possible to remove a longer segment for a greater trunk width reduction? I have a broad back and would be interested in this possibility but wanted to hear his thoughts on risks or considerations (reduced strenght, reach, etc).

2.- Rib Resection

Would there be any benefit or risk to instead of doing the traditional rib resection procedure only removing a segment and leaving the remaining “frontal/tip” part of the rib floating? Would this give some protection or would this reduce the waist reduction effect? Would this turn into bigger risks with puncturing organs, rib flail, etc?

A: In answer to your two excellent waistline narrowing questions:

1) It would produce even better results to take a longer strip of latissimus dorsi muscle but the limited flank incisions used for rib removal surgery only permit the wedge of muscle to be taken to be so big/long.  A vertical incision on the side of the waistline would permit a much longer width of the muscle to be removed but the aesthetic tradeoff of the scar may be questionable.

2) Your question is whether removing just a central section of the rib and allowing the remaining outer portion to float would produce a similar result as removing the entire outer half of the rib is a good one….and one I have often thought about doing. (rib osteotomy vs rib removal) I suspect if one employed short term corseting to help shape the waistline that it may have similar results as the bony lateral support of the waistline is reduced.

Dr. Barry Eppley

Indianapolis, Indiana