Costoplasty Questions (also called thoracoplasty)
What is a costoplasty or thoracoplasty?
I’ve been asked a few times about the costoplasty procedure I had at the time of my scoliosis surgery, so I thought I would try and answer a few common queries about costoplasties below.
When the spine curves it can also twist, this causes rotation of the rib cage which results in a “rib hump,” this mainly occurs with thoracic curves that affect the ribs. In my case I had a large thoracic curve and a very prominent “rib hump” on my right side, caused by the rotation of the spine. Some scoliosis curves can be large with very little rotation and some can be small with lots of rotation, every case is different.
A costoplasty, also called thoracoplasty, is a separate procedure to the spinal fusion, which can reduce the appearance of the “rib hump” that is most often associated with thoracic curves.
A costoplasty will usually involve the removal of sections of several ribs that protrude – in my case my surgeon removed four sections of rib – ouch!!
The idea is that when the ribs grow back, they will grow back straight, providing you with a flatter back. This procedure can be carried out during the same time as the scoliosis surgery, or sometimes as a separate procedure after the spine has fused.
Note that you can’t have a costoplasty without first having the spinal fusion to stabalise the spine.
Does everyone undergoing scoliosis surgery require a costoplasty?
No. Not everyone with scoliosis will require a costoplasty, it’s generally considered a “cosmetic” procedure. In many cases, especially with the modern instrumentation used nowadays, the surgeon can achieve a fantastic cosmetic outcome without the need for this additional procedure. Also, depending on where the curve is in the spine, the ribs may not be affected and therefore this procedure would not be required. It’s mainly required more for larger, stiffer thoracic curves (like mine). If you have a large rib hump as a result of your scoliosis and are considering spinal fusion, it would be worth discussing the options with your surgeon.
Are you pleased with the results?
Yes. Personally, I had a lot of rotation, my rib hump was very large and I hated it. It made me self-conscious and it was painful and uncomfortable to sit against chairs, this is why I decided to ask my surgeon about the costoplasty.
On reflection I am pleased I had this procedure and I would have it again tomorrow if I had to as the results were so fantastic. My rib hump has disappeared and I still can’t get over how flat my back looks even now. I don’t have many pictures of my rib hump side before surgery as I generally tried not to get that side photographed, however the below pictures shows how my rib hump looked before and after surgery:
Is having a costoplasty painful?
Yes it WAS painful, but that’s not much of a surprise really bearing in mind I had 4 broken ribs! It hurt to breathe, sneeze, laugh, move!!
I would say the costoplasty pain was worse than the pain from my spine and lasted about 6 months. But for me the pain was all worth it and was controlled well with painkillers 🙂
It’s also worth noting that having a costoplasty adds time onto your recovery period – I had to wear a brace for 3 months to protect the healing ribs – whereas many patients are not required to wear a brace following scoliosis surgery.
Are there additional risks to having a costoplasty?
Yes, as with any surgical procedure there are risks and complications that can occur with a costoplasty and you should always discuss all the options and risks with your surgeon before making a decision. For example, it lengthens the duration of the surgery and the time that you are under anesthetic.
Hope this helps please feel free to ask any further questions you may have about this procedure and I’ll do my best to help 🙂
Louise x
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I had scoliosis surgery in 2010 and blog about my experiences living with scoliosis. My aim is to raise awareness of scoliosis and help and inspire others with the condition.
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I'm so upaet my doctor never mentioned this to me. Even after my spinal fusion I'm still so self concious of my rib hump it causes great depression and sadness. I'm 17 and have missed out on all the fun things due to the pain and self consciousness my scoliosis has caused me. I wish I got a costoplasty so much!
that is because there are dangers and unknown long term side effects to a costoplasty operation. Most surgeons I have found tend to steer away from doing it since it is only of cosmetic benefit to the patient.
Sorry to hear you are upset. I know it's not ideal but you can have a costoplasty as a separate op after spinal fusion once you are recovered. May be worth speaking to your dr or surgeon if it bothers you that much. There are risks as with every other op though so you need to weigh everything up.
Im thinking about doing the operation. But my doctor told me they can only correct the ribs below ur shoulderblade. This made me doubt doing it. I am/was afraid that because of this, the top of my rib hump wouldnt change. But seeing you results makes me really happy. my rib hump right now can quiet good be compared to your rib hump before the surgery. Thanks alot for making this blog.
I had 1 question, what ribs did they correct in ur case? I assume only below ur shoulderblade. If this is the case then I have a good idea what to expect.
Hi Tommy, thanks for your comment. They cut sections out of four of my ribs, I’m not sure which ones but I think they must have been below the shoulder blade. My right shoulder blade still sticks out because of the residing curve that’s still there pushing it out – they can’t physically move the shoulder blade! But overall I am happy with the results and the rib hump itself in my case is pretty much gone. If you have any other questions let me know, I’m happy to help 🙂
Louise
Hi Louise, that is great news for me! 🙂
Thanks for replying so fast.
And u don’t have any problems with sitting or laying in bed with ur shoulder blade now? And was it painfull the days after the surgery?
Tommy
Hi Tommy!
No problem 🙂 I don’t have any problems with sitting or laying in bed now but some chairs can still be uncomfortable as my shoulder blade still sticks out slightly. It depends on the chair though. I tend to sit with a cushion behind me most of the time at home as it’s just more comfortable. It was very painful after the surgery, it hurt to cough, breathe in etc. I was given very strong painkillers though which helped to manage the pain.
Louise
You’re so lucky. I wish I could do this. I asked my surgeon and he said they stopped doing it years ago because it leads to reduced lung capacity… Currently looking for another hospital that does do it.
Shriners hospital does it in PA. CAll your local Shrine!!!!!
yeah that’s exactly what my surgeon mentioned as well. I was wondering if your surgeon mentioned this permanent reduction of lung capacity in the long term also affects the kids and teenagers who had it done or just the adults who had it done?
What hospital did you have the procedure at? And do you know if most hospitals in the UK do it?
Hi Lauren,
I had my surgery at Oswestry Orthopaedic hospital. I’m not sure which hospitals will do the costoplasty procedure. I think it probably depends on the surgeon and the severity of the scoliosis/rotation. With modern instrumentation and technique, in most cases a costoplasty isn’t necessary as the surgeon can achieve a great result without the need for one.
Louise x
I am 4 weeks post-op. My surgeon removed sections from 6 of my ribs when he fused my spine to help get rid of the ugly hump. Interestingly, I wasn’t given a back brace. I think a lot of my pain has come from the rib removal rather than the fusion and I still feel really terrible (kind of regret doing this to myself) but aesthetically things are better plus my ribs were used to fuse my spine. Definitely worth talking to surgeons about if you are considering surgery.
I am five weeks post op certainly worth having this done.
Hello Louise,
Thanks for your blog, just wanna know if you could describe how much of the ribs were cut off? I read one had sections of 6 ribs cut so that makes more than just the ribs under the shoulder blade?
Hi Akan,
I’m sorry I’m not too sure. I think it was just sections of the ribs, in my case I think it was 3-4 ribs.
Louise
Hi Louise, I’m 36 yrs old. Had spinal fusion done 20yrs ago, I am having costoplasty done in a few months time. How are you getting on now? I really want this done as I’ve spent too many yrs being self conscious of my hump. Bit scared though that I I’m leaving my organs exposed
Hi Laura, good luck for your costoplasty. I’m sure it will all be ok, don’t worry. I’m doing really well now thank you 🙂 I’m sure you will be pleased with the results. Just remember it’s very painful for a while but once recovered you should be fine. Take care, Louise X
Hi,
are you sure your rib hump did not at least come back or remit a little since your costoplasty operation. Since it seems like if comparing your immediate post op pics of your back to a recent one located on your instagram post here, https://www.instagram.com/p/CLH8WoMH-u3/
It looks like it may have worsened or reverted around the mid back area. I wonder if you noticed it slowly coming back out again throughout the years.
Also my question is if the costoplasty left the incised part of your back still tender and sensitive to pressure to this day or aches occasionally as I have heard that was one of the complaints some people have mentioned, including the slight loss on lung capacity. I am wondering if you’ve experienced these side effects substantial enough to affect your life somehow?
Hi Teddy,
It’s not completely flat but it’s so much better than it was pre-surgery. It hasn’t slowly come back over the years. Immediately post surgery there is a lot of swelling and so it can appear flatter on pictures, plus it depends on the angle of the photo as well. I still have a substantial curve post surgery so they can’t flatten it completely. I don’t suffer with any side effects now, as far as I’m aware.
Does the part where they resected 4 ribs at least feel more tender or sensitive to pressure when like sitting against a chair than how it used to be before your costoplasty operation? I understand you also had this done to alleviate the discomfort stemming from the rib hump when sitting your back against the chairs, but it seems the costoplasty may have made that part of the back where your rib hump used to be also more sensitive or discomforting, does it not?
I also heard from one of your recent testimonial youtube videos after the operation that it may still cause you to cough or be out of breath when you sneeze, i think this heightened sensitivity may be a direct result of the costoplasty they did if I had to guess?
Hi Laura, I assuming you’ve had you’re costoplasty op now and just wondering how it went and how are you now? Where did you have it done as I’m thinking about having the same procedure but don’t know of any surgeons that do it! Many thanks!
Hi Debra,
So sorry for the late reply. I’ve had my surgery cancelled twice now. They need a hdu bed post op just in case and there wasn’t any available on both occasions. I’m due to go back in next week, so fingers crossed. I’m in Ireland, so having it done in Dublin
Laura
Hi, can you give me your experience with the costoplasty??
Hi I am of around the same age as you as well, did you find yourself a costoplasty surgeon willing to do this for cosmetic reasons are your age?
Debra, how did yours go?
Hi Laura,
Wondering if you had the costoplasty done and how it went? I’m considering having one done as well. I’m 35 and had spinal fusion done 21 years ago – very similar to your situation. How was the recovery and were there any longer term negative effects?
Thanks,
Angela
Hi Angela, hope you are well 🙂 I had a costoplasty at the time of my spinal fusion. I remember bad pain around my ribs during recovery when breathing, coughing etc and I had to wear a brace for a few months after. I think a side effect is it may reduce your lung capacity slightly but that’s one to ask your Dr as I’m not 100% certain. The pain didn’t last too long, it’s bit like having broken ribs – similar pain/recovery I think. I was very happy with how it looked afterwards, my back is so flat now. I would suggest speaking with a scoliosis specialist if possible! Take care and good luck. Louise xx
Laura, how are you doing, did you happen to get your costoplasty done? I am not quite sure you would have as easy of time finding a surgeon willing to do this operation for someone your age
Hi Louise, since you had your surgery, are you able to ride roller coasters or dance.
What happens to the rib that was cut ?
Thank you,
Hi Eric,
Thanks for your comment. Yes I can ride roller coasters and dance (only once fully recovered though). The rib actually grows back eventually I believe.
Louise
Hi Louise,
I was wondering if any sides effects were brought to your attention when consultant for the costoplasty surgery? I had a consultation this week and was encouraged by my doctor to not have the procedure done. He mention the lung capacity and how my organs won’t be protected. My question is, where these brought up to you as well? I ask because looking at your pictures, I would say we have a similar posture/back after the scoliosis surgery.
Hi Mia, thanks for your comment. That’s interesting, nothing like that was ever mentioned to me but my surgery was over 10 years ago so maybe things are different. I don’t think they commonly do the costoplasty these days. I do think my lung capacity is reduced but I don’t know 100%. The ribs grow back so I’m not sure about the organs not being protected thing. xx
Well the only way to know for sure is to have a pulmonary function test done, preferrably also during physical exercise which can be requested by your doctor. Anything below 80% FVC, FEV or VC is considered impaired.
@Mia: If your back is like Louise’s post operative pic, then why would you still want to have a costoplasty done as there is hardly any rib hump left only a shoulder blade bump? Whichever the case, my surgeon gave me the exact same response years ago as well that yours did. I can only guess on why Louise didn’t have the same pre-caution said to her is because she was younger(below 30s) when she had hers done, theses surgeons seem to be more conservative with older adults, as well as the fact that the costoplasties are more effective when it comes to reducing larger rib humps rather than smaller ones, like is what I think you have currently as you described.