The safety of rib remodeling, according to the published evidence
The largest published series on this technique covers 3,805 patients across 8 countries, all with one year of follow-up. In that series there were 5 major complications: 4 pneumothorax and 1 hemothorax. This page gathers that figure and every other one, each with the study it comes from.
The largest series, and what it found
Between October 2022 and December 2023, 3,805 women aged 18 to 45 were treated across 8 countries, with or without associated liposuction. All received one year of follow-up.
| What was recorded | Result |
|---|---|
| Major complications | 4 pneumothorax · 1 hemothorax |
| Minor complications | 2 cases of chronic pain associated with bicortical fracture |
| Mean angular change (ribs 10, 11, 12) | 10 degrees |
| Mean waist reduction | 11 cm |
| Satisfaction | measured with BODY-Q, a validated questionnaire |
The authors state that all complications «were managed according to standard clinical practice and resolved without lasting functional consequences in the documented cases».
PRS Global Open 2026 · doi.org/10.1097/GOX.0000000000007929
The technique's own complication, measured separately
One detail worth noting: there is a study dedicated solely to measuring the procedure's characteristic complication. It is uncommon for a team to publish an entire paper on what can go wrong with its own technique.
Bicorticality — the fracture crossing both cortical layers instead of one — was studied in 328 patients:
| What was measured | Result |
|---|---|
| Bicorticality | 15 patients (4.6%), mostly within the first 20 postoperative days |
| Pain reported | 41 patients (12.5%) |
| Pain from corset misuse | 7.9% of the total — unrelated to fracture status |
| Visceral fat in those affected | 12.7% versus 8.0% |
The most useful finding is not the rate but what predicts it: the authors conclude that visceral fat and operative duration weigh more than body mass index. Two patients with the same BMI can carry different risk.
Aesthetic Surgery Journal 2026 · doi.org/10.1093/asj/sjag012
Two technical decisions that exist for safety
Two elements of the procedure are neither aesthetic nor a matter of convenience: they are there because there is a measurement behind them.
1 · Ultrasound is not optional. In a study of 100 patients, the «clack» — the sound signalling the rib has given way — was heard in 90%. But ultrasound confirmed the monocortical fracture in 100%. In one in ten patients the fracture was correctly made without any sound. Going by ear leaves that tenth blind.
PRS Global Open 2024 · doi.org/10.1097/GOX.0000000000005843
2 · The corticotomy is perpendicular, and there is a measured reason. Across 50 porcine ribs, with a calibrated dynamometer, perpendicular corticotomy required 6.67 N against 14.54 N for parallel scraping to achieve the monocortical fracture. Less force means more control over where the fracture stops, and losing that control is precisely what produces bicorticality.
PRS Global Open 2026 · doi.org/10.1097/GOX.0000000000007816
The breathing question, answered with spirometry
It is the reasonable doubt of anyone who understands that ribs move when you breathe. It was measured with spirometry — the standard lung-function test — in 294 women aged 18 to 38: before surgery, at 6 months and at 1 year.
Forced vital capacity, forced expiratory volume in one second, peak expiratory flow and the ratio between them were analysed.
Aesthetic Surgery Journal Open Forum 2026 · doi.org/10.1093/asjof/ojag007
What the smaller series reported
| Study | Complications reported |
|---|---|
| Foundational study · 30 patients | No infection, pneumothorax, hemothorax or respiratory complication. 2 minor skin burns under 0.5 cm, treated without sequelae |
| Thoracic deformities · 20 patients | None during the year of follow-up |
| Survey of 113 surgeons | 2.65% of respondents reported ever having had a serious complication |
That last figure deserves precision, because it is often misquoted: the 2.65% is of surgeons, not of patients. It is the proportion of respondents who said they had experienced a serious complication at some point in their career. A surgeon with four hundred cases and one with twenty count the same. It is not a per-operation rate.
What this evidence cannot promise
Three things, stated plainly.
Pneumothorax is the main risk and it does not go away. It is a known risk of any surgery on the chest wall, not specific to this technique. In the 3,805-patient series it occurred 4 times. Infrequent does not mean impossible.
These studies describe what happened, not what will happen. They are cohorts: they report what occurred in those groups, with those surgeons. They are not a guarantee for an individual patient nor a universal rate.
They are signed by the technique's creator. Dr. Raúl Manzaneda Cipriani is an author or co-author of every work cited on this page. They are peer-reviewed and published with a DOI, but they are not independent studies, and that should be known when reading them.
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 all the published evidence
Read the published reply on the safety survey — it clarifies what the 2.65% measures and acknowledges the table error that was corrected.