However, it involves division of muscles of the thoracic wall which leads to significant postoperative pain that needs to be well controlled to avoid restricted lung function. The incision starts at the anterior axillary line and then passes below the tip of the scapula and is extended superiorly between the posterior midline and medial border of the scapula. The pleural cavity is entered through an intercostal space. In older patients and those with osteoporosis, a short segment of rib is often resected to minimize the risk of a rib fracture.