Before I went to see my current surgeon I was also offered surgery with removal of first rib, scalene and pec minor release.

I'm so glad I got a second opinion. Dr Gharagazloo is looking for a specific abnormality of the first rib and he does not offer surgery unless he knows exactly what is causing the compression and removing that piece alone.

I was very uncomfortable with this ambiguity and "let's remove all that stands in the way just in case" approach.