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When women consider natural tissue breast reconstruction—especially the DIEP flap procedure—many are surprised to learn that it sometimes involves removing a small portion of rib. Naturally, this raises questions and even concerns.
Dr. Oscar Ochoa, a board-certified reconstructive microsurgeon at PRMA, explains the clinical reasoning behind this surgical step—and why it’s nothing to fear.
Is Rib Removal Always Necessary in DIEP Flap Breast Reconstruction?
In DIEP flap surgery, tissue is transferred from the lower abdomen to recreate the breast. To keep this tissue healthy in its new location, microsurgeons connect tiny blood vessels from the flap to blood vessels in the chest—specifically the internal mammary vessels located just behind the rib cage.
“To safely access these vessels, we occasionally need to remove a small segment of the rib—usually just 1 to 2 centimeters near the sternum,” explains Dr. Ochoa. “This allows us to clearly visualize and work with the delicate blood vessels, reducing the risk of damage during the connection process.”
Some surgeons attempt to work between the ribs to avoid removing any bone. While this may sound less invasive, it can actually increase the risk of complications.
“When visibility is limited, it’s much harder to perform the precise, delicate connections these procedures require,” says Dr. Ochoa. “That can extend surgical time and increase the chance of injury to the vessels. Our goal is always to ensure the safest, most reliable outcome for every patient.”
What Are the Risks and Side Effects of Rib Removal?
Understandably, patients often worry about how rib removal might affect breathing or chest function. “The portion we remove is very small and located at the front of the rib cage,” says Dr. Ochoa. “It does not impact lung function, breathing, or the structural integrity of the rib cage.”
In most cases, patients never notice a difference in day-to-day function. Some women may experience tenderness or soreness in the area during the early stages of recovery, but this discomfort typically resolves completely within a few weeks.
Long-Term Impact? Minimal to None
There are also no long-term health consequences from this minor rib removal. It’s a standard, time-tested part of many microsurgical reconstructions performed at leading centers, such as PRMA.
“We’ve performed thousands of DIEP flap surgeries,” Dr. Ochoa reassures. “This small step—when needed—helps us achieve the most successful outcomes while protecting the patient’s safety and the health of the transferred tissue.”
What About “Rib-Sparing” DIEP Flap Techniques?
Some surgeons use a rib-sparing approach during DIEP flap surgery, carefully navigating between the ribs instead of removing a small portion. While this technique may sound less invasive, it often limits visibility and working space, which can ultimately increase the risk of damaging the delicate blood vessels that keep the tissue alive. It can also add time to the surgery and may not be the safest option for every patient.
What Does DIEP Flap Recovery After Rib Removal Look Like?
If a small portion of rib is removed during your DIEP flap procedure, as mentioned, you may experience mild discomfort or tenderness near the sternum or chest wall in the first few weeks after surgery. This is entirely normal and typically resolves on its own. Most patients begin feeling significantly better within 2 to 6 weeks.
The surgeons at PRMA also follow an Enhanced Recovery After Surgery (ERAS) protocol designed to minimize pain, promote healing, and get you back to feeling like yourself as quickly and comfortably as possible. Our team will guide you every step of the way with personalized support and detailed recovery instructions.
Explore DIEP Flap Surgery in San Antonio Today
Understanding the “why” behind every surgical decision—like rib removal during DIEP flap reconstruction—can help ease anxiety and build confidence in your care.
“Our goal is always to ensure the best possible outcome for every patient,” says Dr. Ochoa. “And sometimes that means removing a small portion of the rib to protect the blood vessels and support long-term success.”
If you’re exploring your breast reconstruction options, whether you’re newly diagnosed or considering revision from implants, our team is here to guide you with honesty, expertise, and compassion. Contact PRMA today to learn more or schedule your consultation. We’re ready to help you reclaim confidence, sensation, and wholeness.
