It does carry risk. It is surgery on the chest wall and no surgery is risk-free. What can be stated is what has been documented: in the largest published study — 3,805 patients from 8 countries, followed for one year — there were 5 major complications: 4 pneumothorax and 1 hemothorax. This page shows those figures and where they come from.
The figures, unvarnished
| Study | What it found | Source |
|---|---|---|
| 3,805 patients, 8 countries, one-year follow-up | 4 pneumothorax and 1 hemothorax (major complications) 2 cases of chronic pain associated with bicortical fracture |
PRS Global Open 2026 |
| 328 patients, a single surgeon | Bicorticality in 15 (4.6%), mostly within the first 20 days Pain in 41 (12.5%); in 7.9% of the total, from corset misuse |
Aesthetic Surgery Journal 2026 |
| Survey of 113 surgeons using the technique | 2.65% of respondents reported having had a serious complication | PRS Global Open 2025 |
| 30 patients, foundational study | No pneumothorax, hemothorax, infection or respiratory complication 2 minor skin burns under 0.5 cm, treated |
PRS Global Open 2023 |
How to read those figures
They describe what happened, not what will happen. These are cohort studies: they report what occurred in those groups, with those surgeons. They are not a guarantee for any individual patient, nor a universal rate.
The 2.65% is not of patients. It is the proportion of surveyed surgeons who said they had had a serious complication at some point. That is a different figure and should not be confused with a per-operation risk.
The studies are signed by the technique's creator. All four evaluate RibXcar — the incisionless, ultrasound-guided modality of rib remodeling — and Dr. Raúl Manzaneda Cipriani, who developed it, is an author or co-author of all four. That does not invalidate them — they are peer-reviewed and published with a DOI — but it should be known when reading them.
What each complication is, in plain terms
Pneumothorax. Air enters between the lung and the chest wall, and the lung partially collapses. It is the main risk of any surgery on the ribs, not of this technique in particular. It is detected and treated; in the documented cases it resolved.
Bicorticality. The technique aims to break only the outer bone layer. If the fracture also goes through the inner one, that is bicorticality. It is the procedure's own complication and the most frequent: 4.6% in a 328-patient study. It associates more with visceral fat and how long the operation takes than with the patient's weight.
Pain. In that same cohort, 41 patients (12.5%) reported pain. But in most cases the pain came from corset misuse, not from the fracture. That is a useful data point: much of the postoperative pain depends on following instructions properly.
Four questions to ask your surgeon
More useful than any brochure. A surgeon who answers these four with concrete numbers is telling you far more than one who answers with adjectives.
- How many cases of this technique have you done?
- Do you use ultrasound guidance during the procedure? The technique is described with real-time ultrasound; doing it blind is something else.
- What complications have you had, and how did you manage them? "None, ever" in chest wall surgery is an answer worth following up on.
- What follow-up will you provide? The studies showing good results follow patients for a year.
This page reports on published evidence. It does not replace a medical consultation and cannot determine whether you are a candidate. That decision belongs to a board-certified plastic surgeon who examines you.
See the 3,805-case study in detail · See the bicorticality study · All published evidence