Background: The presentation and excision of cysts are a mundane procedural request by patients to their plastic surgeon. They often are not the primary procedure the patient is undergoing and usually a ‘hey doc’ request as an addition. Such lumps and bumps are usually garden variety dermoid cysts and lipomatous masses that can develop anywhere on the body.
But cysts in the buttocks are a little different since this is a common intramuscular injection site for a variety of agents and medications. The most common injection material in the buttocks is fat for aesthetic augmentation who are well known to produce inert oil cysts composed of fatty acids from dead fat. Another cause of buttock cysts from aesthetic injections is a variety of agents from FDA approved and non-approved injectable fillers.
Another other type of injection buttock cyst is from medications such as steroids. Such steroid injections are used in the treatment of medical conditions as well as off label uses for muscle building. Such cysts occur because they end up in the more superficial subcutaneous tissues and not the deeper muscle. This most commonly occurs due to non-professional or self-injectors. While always presenting as a classic hard and immobile cyst externally their contents may have unusual appearances from the typical cysts seen.
Case Study: This male was undergoing a variety of facial plastic surgery procedures in which he requested whether a left gluteal cysts could be excised at the same time.
After the facial procedures were completed the left gluteal cysts was treated by exposing it through a small incision. It was much larger than it looked on the outside, measuring 3 x 3 mms, and was located on the outside of the muscle.
Once dissected around it to its muscle base, in an effort to keep the incision length small, the cyst was opened and decompressed. Its contents were a thick golden-colored material that looked like dermoid cyst contents with the exception of its color. Once the cyst was decompressed the entire sac lining could be removed through the small incision.
In talking to the patient the next day he revealed the history of the cyst. Many years ago to gain weight and muscle mass he self-injected Trien or Trenbolone Acetate, a well known anabolic steroid used in veterinary medicine for cattle. It is also used in humans for budding muscle and is known to be quite effective for that purpose. Of greater relevance is that it has a gold color…which explains the never been seen before (by me) cystic contents.
While it is advantageous to get the cyst removed it is important to remember it is a space occupying mass. Therefore it can be expected, beyond the scar, that there will be an indented buttock contour deformity later. The patient may need a secondary buttock indentation repair later with fat grafting.
Case Highlights:
1) Buttock contour deformities are well known adverse sequelae from steroid injections amongst body builders and those seeking performance enhancements.
2) In this case of known buttock injections with a steroid a cyst had developed whose contents were a golden yellow material whose color is consistent with the anabolic steroid Trenbolone.
3) The excision of large buttock cysts can be expected to result in a subsequent indented contour deformity.
Dr. Barry Eppley
Indianapolis, Indiana