Rib Removal-Eve Born Again!by Sheila Kirk, M.D.
erhaps 10 years ago I attended a meeting in Chicago that was primarily a social event. Among the many new acquaintances I met was a pre-op male to female who was very attractive and who wanted to show me what she had done to accomplish a very female figure. I was hesitant but finally I agreed to go to the room in the hotel to see just what she had done. Once in her room with another person present (to my relief), she opened her dressing gown to show me a very small waist line and a hip line that was strikingly authentic. There was no corestry or binding of any sort. She had a very female torso. She was quick to tell me that she had surgery done perhaps six months before. She had found a doctor who had removed the two "false" ribs on both sides thereby creating a very feminine figure. Needless to say I was quite taken aback. I asked for the surgeon's name and address and I was refused. That troubled me but I was more surprised to know that such a procedure was available and I had never known about it. Not a month later another transsexual individual contacted me to tell me of having experienced the very same surgical procedure. Once again, I asked about the surgeon but received no reply. I was impressed to the point, however, of mentioning the two experiences in my first edition of Hormone Therapy stating that I didn't know who was performing this kind of surgery. I had a notable number of inquiries but I could never offer any referral. I didn't know where to send individuals wanting this procedure. Now some years later---out of the blue-I have several communications telling me of several different surgeons in different places in the United States doing this procedure and there is a rebirth of interest in our community. Enough to review this option again. I feel it very important to discuss the operation and to give insight into what potentials and problems are associated. Our chest cage, or thorax, is made up of our ribs, 12 pairs in number, the sternum or breast bone in front, and the spinal column in back. It contains the lungs, the heart and major vessels that are part of the vast network of arteries and veins that are the conduits for our blood. All are connected to the spine in back but only the top seven are connected to the sternum. The next 3 are connected by cartilage to each other in front and the last two, known as floating ribs, are free with no connection to any bone or cartilage. They are shorter than the ribs above them and are somewhat pointed. Blood vessels and nerves follow the course of the ribs. These arteries, veins and nerve supply lie in grooves on the inner surface of the ribs, and almost the entire inner surface of the ribs is covered by tissue known as pleura. It is a very delicate membrane which covers the lungs surface as well and, when inflamed with certain lung infections, produces a disorder called pleuritis. I give you this short anatomy lesson, to better understand the surgery involved in removing a portion of the 11th and 12th ribs to create a female waist. When the surgeon makes an incision at the base of the rib cage on both sides, he will cut down to the exterior surface of the 12th and 11th rib (if both are to be removed,) and incise a tissue over the bone surface called the periosteum. He/she extends the incision on the skin and on the periosteal cover of the bone, as far back as he/she intends to remove rib bone. Lifting the perisoteum with special instruments, he/she can separate the blood vessels and nerves while attached to the peritoneum and isolate the desired length of rib bone to be removed. Is it simple? Well, in experienced surgical hands, pretty much so! One advantage is that lung cavity pleura does not descend down to the 11th and 12th ribs until the ribs are in the back of the chest cage-hence danger of injury to the pleura and entry into the pleural space is not usually possible. But the diaphragm is right where it all is happening and on the right side the liver projects up toward the chest cavity to make the right side of the diaphragm higher than the left. If arteries or veins are cut across inadvertently, bleeding can be considerable and if subcostal nerves are injured important nerve conduction is interrupted. Inadvertent injury to the dome of the liver is a potential. The skilled thoracic surgeon knows the anatomy and the techniques for performing this procedure but there can be complications because of the proximity of important blood vessels, nerves and other structures. Is this a must procedure for individuals? I don't think so. The money, the time in convalescence and the risks are such that one might want to consider facial techniques first. Clothing styles and fashions can hide a typical male torso-the face is out there for all to see but not the waistline. Those individuals who want referral to surgeons with some experience in this surgery feel free to contact me.
Sheila Kirk, MD is a Transgender Medicine Specialist, board-certified in Obstetrics and Gynecology and in practice in Pittsburgh, PA. She is a well-known author and leading authority on transgendered medical care and research. Dr. Kirk provides international and national consultations and referrals to the TG community and health care professionals who assist in their care. She can be reached the following ways:
Phone: (412) 781-1092 Fax: (412) 781-1096 mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114 |