While implants are used all over the body from the breasts to the calfs very successfully, their use for buttock augmentation is associated with a more checkered experience. Not that implants anywhere can’t be associated with complications, but buttock implants carry a disproportionate amount of criticism. This is partially due to the availability of fat grafting as a buttock augmentation method that doesn’t carry those same risks. It is also because the buttocks are associated with a unique set of recovery issues.
The successful use of buttock implants for augmentation depends on three critical issues, implant location, implant size and managing patient expectations. Errors in any of these three areas will result in either a postoperative complication or an unhappy patient even if no postoperative complication has occurred.
Buttock implants can be placed either above the muscle (subfascial) or into the muscle. (intramuscular) While surgeons can place them in either tissue plane, the subfascial location is technically easier to do, has an easier patient recovery and permits implants of almost any size to be placed. However, it is associated with a much higher rate of complications including seroma, infection, implant show, encapsulation and buttock deformity. While the intramuscular location is more technically demanding, has a longer recovery and allows only smaller implants to be placed, it results in a much lower number of complications. With rarer exceptions, buttock implants should be placed in the intramuscular location.
When large buttock implants are placed in the subfascial plane, many will eventually migrate inferiorly toward the lower gluteal crease and often not very symmetrically. Conversely, intramuscular implants do not migrate and remain where they are placed as the tight muscular pocket holds them firmly and permanently in place. However the intramuscular pocket only allows smaller implants to be used, usually not bigger than 350cc in volume. In smaller women, volumes of 250cc to 300cc are more appropriate.\ Bigger implants than this volume make it impossible to close the muscle layer over the implant which is crucial to the success of the intramuscular location.
Between the intramuscular location and the size of the implants, patients opting for buttock implants must have realistic expectations. They will not get large or massively sized buttocks and the volume obtained is going to be in the upper half of the buttocks. This makes the best candidates for buttock implants as thin or lean women who do not have enough fat for the Brazilian Butt Lift option and can accept a modest increase in buttock size.
If properly done in the right patient, buttock implants can have very similar and success rates as that of the breast implants.
Dr. Barry Eppley
Indianapolis, Indiana