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Thoracic outlet syndrome (TOS) describes compression of the neurovascular bundle of the brachial plexus, subclavian artery, and/or subclavian vein as they leave the thoracic outlet. A 40-year-old female with history of thoracic outlet syndrome status-post left first rib resection presented in 2021 with symptoms of recurrent TOS due to the presence of a residual first rib. A transaxillary approach was performed and a partial second rib resection was required to remove the residual first rib. At 4½-month follow-up, there was improvement in all symptoms.