Costal Remodeling and the Effect on Abdominal Force Distribution: Intraoperative Changes in Abdominal Wall Tension, Subfascial Pressure, and Respiratory Mechanics

Background Abdominal wall force distribution is a key determinant of surgical biomechanics during lipoabdominoplasty. Rectus plication increases tensile stress and intra-abdominal pressure, potentially affecting respiratory mechanics. The biomechanical impact of costochondral remodeling on these parameters remains poorly characterized. Objectives To evaluate intraoperative changes in abdominal wall tensile forces, subfascial pressure, and peak inspiratory pressure (PIP) during lipoabdominoplasty combined with costochondral remodeling techniques. Methods Between January and December 2023, 82 female patients underwent lipoabdominoplasty with rib remodeling. In 42 patients, tensile forces during rectus abdominis medialization were recorded; in 40, subfascial pressures and peak inspiratory pressure (PIP) were measured before and after plication and rib treatment. Patients were allocated to three groups: (1) RibXcar, (2) FrontXribs, and (3) combined RibXcar + FrontXribs. Measurements were obtained using a dynamometer and a compartment pressure monitor. Results Tensile forces decreased most notably at upper points with FrontXribs (16–18 N) and FrontXribs + RibXcar (20.5–21 N), while intermediate points showed maximal reduction with RibXcar alone (20–21 N). Subfascial pressures decreased at upper points with FrontXribs (7.8–8 mmHg) and combined treatment (6.5–7.5 mmHg). PIP reduction (10–14 cmH2O) was greatest in the combined group. Conclusions Costochondral remodeling reduces abdominal wall tension and is associated with decreased subfascial and inspiratory pressures. These findings support a biomechanical hypothesis with potential implications for vascular perfusion, tissue dynamics, and respiratory mechanics; however, this remains theoretical and requires validation in future outcome-based studies.