Bicorticality is the specific complication rib remodeling tries to avoid: the fracture going through both bone layers instead of one. In a prospective study of 328 patients, it occurred in 15 (4.6%), mostly within the first 20 days. Published in Aesthetic Surgery Journal in 2026.
What bicorticality is, in plain terms
A rib has two layers of hard bone, an outer and an inner one, with spongy bone in between. The RibXcar technique aims to break only the outer layer — a monocortical fracture — so the rib can be angled while the inner structure stays intact.
Bicorticality is when that fracture extends through the inner layer as well. It is the technique's own complication, and it is what this study set out to measure.
What the study found
| What was measured | Result |
|---|---|
| Patients | 328 women · mean age 28.3 · mean BMI 25.3 |
| Period | January to December 2023 |
| Bicorticality | 15 patients (4.6%), mostly within the first 20 days |
| Pain reported | 41 patients (12.5%) |
| Pain from corset misuse | 7.9% of the total — unrelated to the fracture |
| Visceral fat and bicorticality | 12.7% in those who had it, versus 8.0% in those who did not |
The finding that changes patient selection
The most useful part of this study for a surgeon is not the 4.6% figure, but what predicts it.
The authors conclude that visceral fat and operative duration appear more influential than body mass index for complication risk. That is: two patients with the same BMI can carry different risk depending on where the fat sits.
The pain data reads similarly. Of the 41 patients who reported pain, in most cases it came from corset misuse rather than from the fracture. That turns part of postoperative pain into a patient-instruction problem, not a surgical one.
What this study does NOT say
Three limits worth keeping in mind:
It is a single surgeon. All 328 patients were operated by one operator. That makes the series very consistent, but it does not tell you what happens when others apply the technique. For that, see the multicenter cohort of 3,805 cases across 8 countries.
It is level of evidence 4. The authors state this in the article. A prospective case series is useful and honest, but it is not a comparative trial: it describes what happened in this group, with no control group.
It is not an independent study. The creator of the technique is the first author. That should be stated.
Why publish your own complication
A study dedicated to measuring the specific complication of one's own technique is uncommon, and it is the kind of evidence a surgeon evaluating adoption needs: not how much the waist reduces, but what goes wrong, how often, and in whom.