Body implants, primarily for muscle augmentation, can be done for a variety of anatomic sites including the chest, shoulders, arms, buttock and calfs. While some of these implanted areas are new, the calfs represent one of the original types of body implants. Calf implants have been around now for several decades using a variety of silicone implant shapes.
The calfs acquire their shape by several factors including the size of the gastrocnemius and soleus muscles, the length and orientation of the crural bones, and the amount of fat between the skin and the underlying muscles. Some people have naturally thin or underdeveloped calf muscles that remain small no matter how much exercise they do. Calf implants can be used aesthetically to make the inner or outer heads of the gastrocnemius muscles appear larger by placing an implant on top of the muscle but below its investing fascia.
Calf implant surgery is fairly straightforward. The superficial anatomy of the calfs is not confounded by neurovascular structures nor being deeply embedded beneath a lot of tissues. The incision(s) are behind the knees, the entrance through the fascia of the gastrocnemius muscles is fairly easy to find, the subfascial plane is developed with long instruments, the chosen implant is slid into place and the incision is closed in multiple layers. Within an hour the calfs of both legs can be augmented.
With the relatively long history of calf augmentation, even though it is not commonly done, the success of the procedure and the incidence of complications should be well known. Two recently published articles chronicled significant calf augmentation experiences.
In the April 2012 issue of Aesthetic Plastic Surgery, an article entitled ‘ Bilateral Calf Augmentation for Aesthetic Purposes’ was published. Calf implants were placed in 53 patients (40 women and 13 men, 106 implants) over a three year period and followed for an at least one year. Smooth silicone elastomer implants were used. The implant sizes were 125cc in 37 bilateral cases, 70cc implants in 10 cases and 175cc in 6 cases. No infections or hematomas occurred. Three seromas developed. (3%) Four cases of hypertrophic scars (4%) were seen. One patient (1%) wanted the implants were removed. No case of compartment syndrome or deep vein thrombosis was seen. Implant displacement or rotation did not occur. From an aesthetic standpoint, 73% of the patients were completely satisfied and 19% were mainly satisfied. Only 8% of the patients felt that the appearance was not what they wanted.
In the June 2013 issue of the American Journal of Cosmetic Surgery, a published paper entitled ‘Calf Augmentation: A Single Institution Review of Over 200 Cases’ appeared. Over a five year period, a total of 202 calf augmentations were performed using semirigid silicone elastomer implants. They reported a satisfaction rate of 92% (186/202) Dissatisfactions were related to the amount of augmentation achieved or by hypertrophy of the knee scars.
Of all the locations for body augmentation, the calfs represent the ‘simplest’ location for the placement of implants based on the anatomy of the area. These two clinical studies demonstrate that the overall satisfaction rate is high and the complication rate fairly low. To put this in perspective, compare calf implant complication rates to that of breast implants and it is actually far less. The recovery is actually more difficult as it affects walking, as breast implants obviously do not, but the risk of potential complications appears to be much lower.
Dissatisfaction with calf implants largely resolves around the amount of augmentation obtained. Any patient’s interpretation of calf size is obviously subjective but there are limits to the size of calf implants that can be safely placed. The range of calf implant volumes is always less than 200cc, usually being between 70cc and 170cc with 125cc being the most common size calf implant placed in my practice. Larger implants, particularly if both muscle heads are implanted in each leg, raises concerns about the potential for a compartment syndrome or deep vein thrombosis (DVT) after implantation due to the compression of the deeper vessels. At the least over sizing implants in the calfs makes for a more uncomfortable and prolonged walking recovery.
Now that fat injections are becoming a standard option in plastic surgery for soft tissue augmentation, how well a synthetic implant performs by comparison is important to know. Implants offer an effective and low risk option for calf augmentation.
Dr. Barry Eppley
Indianapolis, Indiana