Rib removal (or more commonly partial 10th/11th/12th rib resection for waist narrowing) and buttock augmentation can be combined in a single operation, but whether it is advisable depends on the specific buttock procedure and the patient’s anatomy, operative time, and risk profile.
Key considerations:
- Positioning: Rib resection is usually performed with the patient prone or in a lateral position, and buttock augmentation often requires prone positioning as well. This can make the procedures technically compatible from a positioning standpoint.
- Type of buttock augmentation:
- Gluteal implants can be combined relatively straightforwardly from a logistical standpoint.
- Fat grafting (Brazilian Butt Lift) can also be combined if adequate donor fat is available. In fact, waist narrowing from rib modification and increased buttock projection can create a more dramatic waist-to-hip ratio.
- Operative time: Combining procedures increases surgical time, which can increase risks such as blood clots, wound healing issues, and prolonged recovery.
- Recovery considerations: Rib surgery can cause discomfort with breathing, twisting, and upper body movement, while buttock augmentation affects sitting and lower body activities. Recovery protocols need to be coordinated carefully.
- Safety: If large-volume liposuction is being performed for fat harvesting, along with rib surgery and buttock augmentation, the total surgical burden should be evaluated carefully. Some surgeons may stage the procedures depending on the extent of correction desired.
- Aesthetic planning: The combination is often sought because both procedures aim to enhance the torso-to-hip ratio. Proper preoperative analysis is important to determine how much improvement can be achieved with liposuction alone versus adding rib modification.
If you’re asking from a surgical planning perspective, the answer is generally yes, they can be combined, and many body-contouring surgeons would consider them complementary procedures when performed on an appropriate candidate. The exact recommendation depends on whether the buttock augmentation is by implants or fat grafting, the amount of liposuction planned, and the patient’s overall health.
With buttock implants
Yes. Rib removal and buttock implants can be performed together during the same operation and there are some advantages to doing so:
- Both procedures are typically performed with the patient in the prone position, simplifying operative logistics.
- The combination can significantly enhance the waist-to-hip ratio, with rib reduction narrowing the waist and implants increasing buttock projection and width.
- Unlike a BBL, there is no need for extensive liposuction or fat harvest if implants alone are used.
However, there are several issues to consider:
- Implant pocket integrity
- The rib resection incisions are usually higher on the flank than the gluteal implant pockets, but care must be taken to keep the surgical planes separate to minimize infection risk.
- Recovery
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- Rib surgery causes discomfort with twisting, coughing, and certain upper-body movements.
- Buttock implants require restrictions on sitting and direct pressure.
- The combination can make the early recovery period more challenging than either procedure alone.
- Operative time and drains
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- Both procedures commonly require drains, and combining them increases operative time and postoperative management complexity.
- Implant-related risks
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- Buttock implants have higher complication rates than many other implants, including seroma, infection, wound separation, implant displacement, and the potential need for revision surgery.
From a body-contouring standpoint, the combination is anatomically reasonable and can create a very powerful silhouette change. The main question is whether the patient’s health, soft-tissue characteristics, and recovery tolerance make a combined procedure preferable to staging them.
In my experience, if a patient is committed to gluteal implants rather than fat grafting, combining them with waist narrowing via 11th and 12th rib modification is technically feasible and can produce a particularly dramatic waist-to-hip enhancement.