Rib removal is used to create an hourglass figure as an adjunctive procedure to abdominoplasty which elevates, redrapes and tightens the abdomen and waist. The floating ribs (numbers 11 and 12) do not come all the way around to meet the breast bone in the front. Number 12 is only on the back and sides while 11 does come to the front of the body. Most of ribs 11 and 12 and occasionally 10 are removed to give patients a more feminine hourglass figure via an abdominoplasty incision. This operation should not be treated lightly. It is not reversible and should be done in the hospital with an overnight stay. The patient has to be a candidate for an abdominoplasty before rib removal is performed. The ribs do not grow back.
This patient has had a previous abdominoplasty with the outer edges of the lower abdominal incision placed to low and an unsightly round scar around the belly button. Revision involved raising the outer ends of the lower scar to allow the scar to lie within the boundaries of bikini skin tan lines and make it more easily hidden under clothing. Ribs 10, 11 and 12 were removed on the front and sides of the chest at the time of surgery leaving the back portion of the ribs intact for protection against trauma to internal organs. Although the hourglass shape after surgery is apparent rib removal in and of itself will not decrease one’s waist size or circumference. That is accomplished by the abdominoplasty portion of the operation.
Breast surgery was performed elsewhere by another surgeon.
46 year old, 5’8″, 167 pound patient 31 days after liposuction, tummytuck revision, rib removal, and fat transfer to the buttocks augmentation i.e. Brazilian butt lift, Latin butt.
Video: Redo Abdominoplasty with Rib Removal
Read Dr. Stone’s blog about abdominoplasty and belt lipectomy surgeryAbdominoplasty, thigh buttock lift and belt lipectomy
Abdominal Muscle Tightening and Diastasis Repair
The Difference between Panniculectomy and Abdominoplasty – Tummy Tuck
Rib removal surgery can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.
For those who cannot afford or do not want rib removal a combination of abdominoplasty, liposuction and fat grafting can give you an hour glass figure though not to the extent of additional rib removal.
As with any type of surgery there is the risk of infection or bleeding. Additionally there is the risk of seroma or blood fluid collections under the skin, bruising and skin loss especially at the lower edge of the abdominal skin below the belly button and the middle of the lower back. Smokers and those who have undergone massive weight loss prior to surgery are at particular risk for skin loss or clots in the major leg veins.
During removal of rib(s) a tear may occur in the thin tissue surrounding the lungs. Air may then collect between the chest wall and lung preventing full expansion of the lungs. This air is usually absorbed by the body and no treatment other than a few chest x-rays to monitor its absorption are required. Rarely a tube (chest tube) is required to maintain the lung(s) at full inflation. Should this occur you would need to remain in a hospital until the tube is no longer required, 3 to 7 days. These tubes are usually placed via the skin crease under the breast in order to hide the access site scar. Since the lung space ends between the 9th and 10th ribs and only ribs 11 and 12 are removed the risk of this occurring witht the described rib removal is actually less than it is for breast augmentation.
I have also seen one patient who developed a stomach bulge due to a weakness of the abdominal muscles in one area. This was not a hernia and can be treated with additional surgery to tighten the muscle creating the bulge.
This risks are minimized by careful surgery, use of drains, medical optimization of at risk patients before surgery, early ambulation after surgery and adherence to postoperative instructions.
Constipation is a frequent problem following muscle tightening surgery and opioid pain medications after surgery. Dr. Stone has his patients routinely take stool softeners beginning a few days before surgery to minimize this problem.
The appearance of the skin incision scars after surgery is highly variable from patient to patient. With good scar control regimens after surgery the visible scarring can be minimal even in Afro-Americans.
The benefits are not being self conscious shopping for clothes, in a bathing suit at the beach, when wearing midrif exposing shirts or when being intimate and achieving a more hourglass shape for women. Being pleased with your new appearance can be a major incentive to changing your lifestyle, diet and exercise regularity in order to maintain your new look.
All patients require an overnight stay in the hospital and the procedure must be done in the hospital to ensure safety. Most patients stay in the hospital for 2 or 3 nights. Since the initial days of recovery are painful patients use a patient contolled anesthesia machine while in the hospital so they do not have to wait for a nurse for pain medication. A urinary catheter is left in place overnight and the drains are removed within 3 to 7 days of surgery in most cases. Patients use an incentive spirometer after surgery to ensure that their lungs are fully aerated.
The main factor affecting complication free recovery is the amount of muscle tightening that is performed at surgery. If the muscles were very lax before surgery you may not be able to walk upright for 2 or 3 weeks after surgery. There are exercise and activity restrictions for 3 to 4 weeks after surgery after which patients gradually return to their pre-surgery exercise routines.
Dr. Aaron Stone
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Culver City, Los Angeles,CA 90232