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Buttock implants are the alternative procedure to the Brazilian Butt Lift. (buttock augmentation by fat injections) When one doesn’t have enough fat for injection or has ‘failed’ a fat injection procedure, implants are the remaining option for buttock augmentation. Once having a more checkered clinical history with a high rate of complications, buttock implants have now evolved into a more reliable procedure with a higher long-term success rate and a complication rate consistent with that of other body implants.

Besides improvements in implant design and of the materials of which they are composed, the biggest change has been the internal pocket in which the implant is placed. Historically placing the implant on top of the muscle (subfascial pocket) was the only location used, but the introduction and refinement of the intramuscular pocket has been the greatest reason complication rates have fallen. The intramuscularly pocket lowers the infection risks, has less occurrence of serums and virtually eliminates any risk of inferior implant descent.

Unlike the subfascial location, the intramuscular pocket is much harder to properly and safely make. It is not easy to understand how to do it in a textbook or lecture. Only doing cadaver dissections can the surgeon really understand and master the technique. This is because it is not a natural tissue plane that is being made. Rather the gluteus maxims muscle is being artificially split through its middle to create the pocket. It is must be thick enough to have adequate muscle over the implant that does not atrophy over time. Conversely the muscle dissection can not be too deep  that there is risk to the sciatic nerve.

The buttock implants must then be placed inside the intramuscular pocket and the muscle closed over it. By locking into a tissue pocket that is complete surrounded by muscle, it is easy to understand why the complications rates are lower than when above the muscle. The early recovery may be more difficult but is worth the long-term benefits.

The caveat to the intramuscular pocket, and a trade-off for all patients to understand, is that the size of the buttock implants is not unlimited. Most patients can have only 300 to 400cc implant sizes placed.

Dr. Barry Eppley

Indianapolis, Indiana

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