Other remote dangers of rib surgery include injury to the nerves that run underneath the ribs as well as damage to the kidneys, which sit deep behind the floating ribs. Cosmetic risks include asymmetry, visible scars, and ribs that revert back to their original position (mainly from improper corset use, experts say). In rare cases, “you can get something called a nonunion, where the bones, for one reason or another, don’t quite heal,” Dr. Sieber says, “so they never re-ossify and they’re kind of just floating sections next to each other.”
Critics of the procedure worry about the surgery’s impact on the lungs over time: If rib removal can compromise breathing, could rib remodeling pose a similar risk? The rib cage does play a role in respiration by providing space for the lungs to fully expand. When you undergo a procedure that “intentionally shrinks the lower portion of the chest wall, you’re impinging on the space that the lungs are meant to have,” Dr. Rubinstein explains. “The tighter you make it when attempting to pull in the waistline, the less space the lungs have for taking deep breaths.”
Dr. Turin likens the effect to inhaling deeply while wearing a corset or Spanx. “It can be done, but it’s a bit harder than breathing unrestricted,” he says. After surgery, he posits, a patient’s pulmonary function tests could look a little different, but in his opinion, that slight change would be “relatively immaterial to the majority of the population.” Dr. Hadeed adds that “the lungs typically only extend down to about the 10th rib,” and it’s generally the 11th and 12th ribs that are repositioned.
Dr. Teitelbaum argues that even a small loss of pulmonary function may, in fact, be meaningful—“dismissing it would be like saying a small heart attack is irrelevant for most people”—and that doctors should screen for and precisely analyze any potential changes by performing pulmonary function tests before and after rib remodeling to see how patients’ lungs fare. “These things need to be known,” he says. Presently, however, such testing isn’t standard practice. None of the surgeons I spoke to who perform rib remodeling do these before-and-after pulmonary tests, maintaining that they’re unwarranted.
Overall, data is lacking. “Rib remodeling hasn’t been around that long, so there are few studies even looking at the techniques and results, let alone pulmonary function and the dynamics of breathing as it relates to the changes these operations make,” says Dr. Rubinstein. I did find one study from 2024 detailing a remodeling treatment for “winged ribs” (a medical condition where the ribs visibly and palpably protrude from the chest). Surgeons reduced the ribs from the front of the body (versus the lower back, as is customary) and conducted pulmonary tests on patients pre- and post-op. They recorded no significant changes in lung function six months after surgery. (With the approach for winged ribs, surgeons are working in “much closer proximity to the lungs” than they are during traditional rib remodeling,” Dr. Hadeed says.)
While Dr. Rubinstein has concerns about rib remodeling, he doesn’t dismiss the procedure out of hand. “I think there’s a role for almost everything in the right circumstances—if the patient can be well informed of the risks and if the procedure can be done with a high enough level of safety and satisfaction,” he says. Looking ahead, he adds, “there may come a time in the not-so-distant future when this is just another procedure that we do.” The BBL seemed exotic 20 years ago, he reminds me, but today it’s performed routinely in ORs across the country.
Dr. Teitelbaum thinks the emergence of rib remodeling raises “an interesting moral question—should plastic surgeons do whatever a patient wants, however ludicrous? Is this any different than giant breast implants or overinflated lips?”
But then there’s this question: Who defines “ludicrous”?
For now, says Dr. Rubinstein, “I’m sitting back and waiting to see how rib remodeling pans out before I start offering it to my patients. I am one who thinks it’s a long run for a short slide.”
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