RibXcar is a newer surgical technique in plastic and reconstructive surgery, and it represents a significant step forward in how rib remodelling is performed. Unlike older rib surgery methods that require large incisions, RibXcar uses entry points of approximately one millimetre or less, guided throughout by ultrasound. The procedure works by creating a controlled fracture in the lower ribs and repositioning them, without removing any bone. Understanding what the procedure involves, who it may suit, and what recovery requires is an important part of making an informed decision about whether a surgical consultation is appropriate for you.
What Is Rib Remodelling, and How Does It Differ From Rib Removal?
If you have been looking into surgical options for the waist area, you may have come across both rib removal and rib remodelling. These are two different procedures, and it helps to understand how they differ before booking a consultation.
Rib removal, also known as costectomy, involves surgically extracting one or more of the lower ribs. It requires more extensive incisions, a longer recovery, and permanently alters the structure of the rib cage. RibXcar, by contrast, does not remove any ribs. Instead, a controlled fracture is created in the outer layer of the lower ribs, known as a monocortical fracture, and those ribs are then repositioned to produce a narrower waist profile. The rib cage remains structurally intact and continues to protect the organs it surrounds.
RibXcar takes this a step further by performing the entire procedure under continuous ultrasound guidance, through entry points that are approximately one millimetre or less in size. There are no large incisions, and scarring at the entry points varies between patients depending on individual healing and skin type.
What Happens Before the Procedure?
Before the procedure, a thorough consultation takes place. The consultation covers your anatomy, goals, health history, the procedure itself, the associated risks, and what the recovery period involves.
Pre-operative imaging, such as a CT scan, is often arranged to allow precise surgical planning. This helps with mapping the position and anatomy of your lower ribs before the day of the procedure.
You will also receive guidance on what to do before the procedure, including any medications to avoid, fasting requirements, and what to arrange for your recovery at home. This preparation stage is an important part of the overall process and gives you the opportunity to ask any questions before proceeding.
What Does the Surgical Procedure Involve?
The RibXcar technique is performed under general anaesthesia. Ultrasound is used throughout the procedure to locate and monitor the lower floating ribs, specifically ribs 10, 11, and 12. These are the ribs with no connection to the sternum and are naturally more mobile than the ribs above them.
A specialised instrument called a piezotome is introduced through the tiny entry points. A piezotome uses high-frequency vibrations, producing up to 30,000 vibrations per second, to carefully weaken the outer cortex of the rib bone without disrupting the surrounding soft tissue, vessels, nerves, or muscles. Once the bone has been appropriately weakened, controlled manual pressure creates the monocortical fracture. The ribs are then repositioned to reduce the width of the lower torso.
The entire procedure generally takes one to two hours, depending on the individual’s anatomy and whether any other procedures are being performed at the same time.
Why Is Ultrasound Guidance Important?
The ribs are located close to the lungs, so monitoring throughout the procedure is clinically important. Ultrasound allows the position and angle of the fracture to be checked in real time, and bone continuity to be assessed as the procedure progresses.
Ultrasound also helps confirm when the procedure is complete. Before this technique was introduced, doctors relied on a clicking or cracking sound made by the rib during the fracture as a sign that the bone had been properly repositioned. Medical research has since shown that this sound alone is not a reliable way to confirm the procedure is finished, which is why visual confirmation through ultrasound is now considered the more accurate approach.
The use of ultrasound throughout RibXcar is one of the key differences between this approach and earlier rib surgery methods, and is considered an important factor in how accurately the procedure is carried out.
What Is Recovery Like After Surgery?
RibXcar is a surgical procedure and requires careful post-operative management. Recovery time and experience will vary between patients depending on individual factors such as anatomy, overall health, and how closely post-operative instructions are followed.
After the procedure, a compression garment is worn to support the repositioned ribs as the bone heals and sets in its new position. It should be worn continuously for approximately eight weeks, after which imaging is typically arranged to confirm the bone has fully healed. Wearing the compression garment as instructed is an important part of the recovery process.
During the first few weeks, there will be some soreness and swelling around the treated area. Physical activity will need to be reduced during the healing period, and specific guidance will be provided on when it is safe to resume normal daily activities, exercise, and work. Individual results vary, as outcomes depend on a range of factors including anatomy, how well the compression garment is worn, and individual healing.
What Are the Potential Risks?
As with any surgical procedure, RibXcar carries risks that should be discussed in detail during your consultation. Being well-informed before proceeding is an important part of making a considered decision about surgery.
Potential risks include:
- Pneumothorax (air around the lung)
- Long-term pain or nerve irritation in the treated area
- Difficulty with the bone healing in its new position
- Asymmetry between the two sides
- Infection or reaction at the entry points
- Outcomes that differ from expectations, noting that individual results vary
As with any surgical procedure, risks are present and should be taken seriously. The procedure requires specific training, ultrasound proficiency, and surgical experience. A thorough discussion of all risks with a qualified specialist before proceeding is essential.
Who Might Consider This Procedure?
RibXcar may be considered by patients who are seeking to reduce the width of their lower torso and have realistic expectations about what the procedure can achieve. Clinical discussion around suitability includes considerations such as the patient’s overall health, anatomy, body composition, and commitment to wearing the compression garment during recovery.
The procedure is not a substitute for weight management and is not suitable for everyone. A detailed consultation with a qualified plastic and reconstructive specialist is needed to assess whether it’s an appropriate option for your individual circumstances.
Some patients also choose to combine this procedure with other surgical options such as liposuction (suction-assisted lipectomy) or abdominoplasty. If you’re considering a combined approach, this needs to be discussed thoroughly during your consultation so that the risks and recovery involved can be properly assessed.
Why Choose Dr Perron for Rib Remodelling Surgery in Brisbane
Dr Justin Perron is a Specialist Plastic and Reconstructive Surgeon holding the Fellowship of the Royal Australasian College of Surgeons in Plastic Surgery (FRACS Plastics). He is a member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgery (ASAPS Aust.), and is registered with AHPRA as a specialist plastic and reconstructive surgeon.
Dr Perron has undertaken specialist certification in the RibXcar technique through a training program in Paris, which is recognised internationally as a specialist training program for this procedure. The Paris program covers patient assessment, treatment planning, the surgical technique itself, and the post-operative protocols specific to RibXcar.
Dr Perron also brings more than a decade of experience in plastic and reconstructive surgery in Brisbane. A consultation gives you the opportunity to ask questions, discuss your circumstances, and receive a clinical assessment of whether this procedure is an appropriate option for you.
