Rib remodeling as a thoracic feminization strategy in transfeminine patients: Case report

Background: Gender-affirming surgery is a cornerstone of comprehensive care for transgender individuals. In transfeminine patients, the waist-to-hip ratio (WHR) plays a decisive role in the perception of femininity. Rib remodeling has recently been described as an innovative adjunct to thoracic feminization. Case presentation: We present the case of a 30-year-old transfeminine patient who underwent breast augmentation with 300 cc silicone implants combined with rib remodeling using the RibXcar technique. Preoperatively, the WHR was 0.9 (waist: 77 cm; hips: 84 cm). Controlled fractures of the 10th-12th ribs were performed via small posterior axillary incisions. Results: At 4 months, CT imaging confirmed rib remodeling with reduced intercostal distances. Waist circumference decreased to 67 cm, yielding a WHR of 0.8. The patient reported high satisfaction, improved body congruence, and no respiratory or functional complications. Conclusion: Rib remodeling appears to be a safe and effective adjunct for thoracic feminization in carefully selected transfeminine patients.