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Background: The most common form of body reshaping surgery today is probably BBL or Brazilian Butt Lift surgery. Decades ago it was breast augmentation and a tummy tuck which was often done on older women usually past the child bearing years. (aka Mommy makeover) The difference in BBL surgery from traditional Mommy Makeovers is that they are often done in younger women, even before they have had any children, and it is a purely autologous procedure. It is the massive redistribution of fat from undesired body areas to more desired locations. (buttocks and hips)

While BBL surgery can be tremendously effective it does not work for everyone and some patients are not even candidates to consider having it. It all comes down to how much fat do you have to harvest and how well does it survive once transferred. There are lots of surgical ‘recipes’ for harvesting fat and transplanting it that purportedly have high rates of success. And while these techniques may be perfectly valid some patients with low fat supplies or certain body types may preclude effective results and they may seek alternative approaches for improvement. For those patients who have little fat to harvest, weight gain aside to try and achieve a good supply, they may have no choice but to turn right from the beginning to an alternative surgical approach.

The alternative to fat injections for buttock augmentation are buttock implants. The alternative to liposuction for waistline narrowing is rib removal. These two procedures can be done together to try and affect the diametric effects of waistline narrowing and buttock enlargement. While the intraoperative prone position is an opportune time to do both procedures it takes a ‘qualified’ patient to do so due to the recovery required.

Case Study: This female previously had BBL surgery, which will providing improvement, did not achieve the result she was seeking. She presented for the combo rib removal-buttock implants and I agreed to do so based on her prior surgical history as well as being able to come to surgery with someone to help her in the immediate recovery period. 

Under general anesthesia and in the prone position 330cc intramuscular buttock implants were placed through a midline intergluteal skin incision. Then removal of the outer ends of ribs #11 and #12 were done with wedges of latissimus dorsi muscle removed from small oblique lateral back incisions.

This combination surgery has a diametric effect, just like BBL surgery, with further narrowing of the waistline and enlargement of the buttocks beneath it. 

Recovery for the rib removal consists of a day or two of having back drains in place and wearing a circumferential support. (binder, waster trainer etc) The incisions are closed with dissolvable sutures and covered with glued on tapes which stay in place for weeks. One can shower and get them wet. There aren’t really any postoperative restrictions since you can’t really hurt the surgically changed anatomy. The hardest part is getting up and down initially since this is what much of your core back muscles do in terms of everyday activities. But what really adds to the immediate recovery is the trauma to the gluteus maximus muscles with the implant placements. This makes it initially hard to find a comfortable position in which to sit or lay. I don’t usually use drains for intramuscular buttock implants. It is always best to use permanent sutures in the intergluteal skin closure that have to be removed since this protects the integrity of the closure better than resorvable sutures. Most patients are going to stay five to seven days before embarking on the journey home. It will take up to a month after the surgery until one feels really comfortable again sitting for an extended period of time. 

Case Highlights:

1) The most common form of lower body reshaping today is BBL surgery which is not maximally effective for everyone.

2) Beyond BBL surgery lies the combination of rib removal and buttock implants as the definitive body reshaping procedure for failed BBL or non-candidate BBL patients.

3) Rib removal and buttock implants is a convenient surgery by intraoperative positioning but one has to be prepared for the recovery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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