Indications and Contraindications for Minimally Invasive Rib Remodeling

Background: A narrow waist is one of the central objectives of aesthetic body contour-ing, and it is closely tied to the waist-to-hip ratio that observers associate with a feminine silhouette. Conventional soft-tissue techniques such as liposuction and liposculpture are constrained by patient-specific anatomy, including the pattern of adipose tissue distribution and the transverse dimensions of the bony rib cage. Minimally invasive rib re-modeling was developed to overcome these constraints and to produce a more pronounced waist-narrowing effect without rib removal. The factors that determine the magnitude of the result and patient satisfaction have not been characterized in sufficient detail. Methods: A combined retrospective–prospective single-center study was conducted on 60 female patients aged 22 to 55 years (mean age, 35.5 years) who underwent minimally invasive rib remodeling using the Kudzaev technique between 2017 and 2025. The variables assessed included anthropometric measurements, body mass index (BMI), sub-cutaneous and visceral adipose distribution, body shape, endocrine status, and psycho-logical readiness to adhere to the postoperative regimen. Outcomes were evaluated at three months on the basis of the change in waist circumference, standardized photo-graphic documentation, and patient satisfaction (5-point scale) and the BODY-Q Satis-faction with body scale. Results: The mean reduction in waist circumference was 7.82 ± 2.14 cm. Both the re-duction and patient satisfaction decreased with increasing BMI (Pearson r = −0.30 and −0.42, respectively): patients with a BMI ≤ 25 kg/m² (n = 59) achieved a mean reduction of 7.86 ± 2.12 cm and a satisfaction score of 4.25 ± 0.96, whereas the single patient with a BMI > 25 kg/m² obtained a smaller reduction (5 cm) and the lowest satisfaction score. The BODY-Q Satisfaction with body scale corroborated these results (Rasch-transformed score, 82.6 ± 18.3) and correlated strongly with the 5-point rating (Pearson r = 0.90). Elevated BMI and a pronounced visceral fat component were associated with a less favorable aesthetic outcome. Endocrine disease, in particular hyperparathyroidism, was associated with delayed rib consolidation and lower satisfaction. Poor postoperative compliance, especially inconsistent corset wear, was linked to unsatisfactory results. Conclusions: The effectiveness of minimally invasive rib remodeling depends substantially on patient selection. The most favorable outcomes were obtained in patients with a normal BMI, minimal adipose tissue, and a high level of compliance. Elevated BMI, excess visceral fat, endocrine disorders, and low motivation are risk factors for an unfavorable outcome. These findings support rigorous preoperative selection that accounts for both somatic and behavioral characteristics.