Implants are the treatment option for buttock augmentation when either fat grafting has failed or there are insufficient fat donor sites to adequately do the procedure. Even though buttock implants offer an assured volume, fat grafting should be considered first if there us adequate fat to harvest.
Very similar to breast implants, buttock implants have options to consider in implant size as well as pocket location. While breast implants can be placed below (submuscular) or above the muscle (subglandular), buttock implants can be placed on top of the muscle (subfascial) or inside the muscle. (intramuscular) Unlike the pectoralis muscle on the chest in which there is a well defined submuscuar plane with a protective ribcage underneath, the gluteus maximus muscle is different. Underneath the gluteus maximus muscle is the sciatic nerve so a submuscular position is not possible.
Buttock implants must be placed inside the thick gluteus maximus muscle because of the underlying sciatic nerve. This is not a natural or easy plane to make by dissection and it also induces limits of how big of an implant can be placed inside the muscle. While an effective procedure it is fairly traumatic to the muscle and this is why it is one of the harder body contouring procedures from both a surgeon’s technical standpoint as well as that from a patient’s recovery standpoint.
The surgical technique for intramuscular buttock implants begins with standard 7cm long intergluteal incision. The medial part of the muscle close to the sacrum is identified by subfascial dissection. One technique to making the intramuscular pocket begins with separating the muscle fibers parallel to the orientation. From there the intramuscular pocket is developed using various instruments.
While the intramuscular pocket for buttock implants is hard for both surgeon and the patient, its pays long-term dividends by having a much lower risk of either immediate or long-term postoperative problems. The one beat about the intramuscular pocket is that the size of the buttock implants able to be placed will usually under 400ccs.
Dr. Barry Eppley
Indianapolis, Indiana