Practice-Based Patient Management Strategies in Gluteal Augmentation with Implants.

This article focuses on practice-based recommendations for surgeons performing gluteal augmentation with implants (GAI). Preoperative planning, including the indications, precautions, and contraindications to GAI, is discussed. Advantages and disadvantages of subfascial and intramuscular implantation are addressed along with recommendations for implant size, shape, and position. Recommendations for patient management before and after surgery along with operative and nonoperative strategies for postoperative complications, including wound dehiscence, infection, and seroma, are included. Aesthetic concerns and recommendations for the management of poor results are addressed. A comprehensive literature review is included along with illustrative preoperative and postoperative photos.

Biceps Augmentation Using Solid Silicone Implants.

BACKGROUND: Biceps augmentation using solid silicone implants has been increasingly requested in recent years despite a paucity of literature evaluating the safety and efficacy of this procedure. OBJECTIVES: The purpose of this study was to provide information about complications, surgical planning, and aesthetic outcomes of biceps augmentation. METHODS: A retrospective chart review was conducted for patients undergoing solid silicone biceps augmentation in the author's practice from April 2011 through May 2016. Collected data were analyzed to assess the indications for surgery, quantity of complications, and need for surgical revision, and to evaluate aesthetic outcome. RESULTS: Twenty-one male patients were included in the study. The mean age was 42.6 years and the mean follow up was 7.1 months. Indications for surgery include a desire to increase biceps size (n = 16), and correction of biceps deformity after biceps tendon rupture (n = 5). Eight patients underwent subfascial implant placement and 13 submuscular implant placement. Complications occurred in 10 patients (48%) including asymmetry (n = 4), seroma (n = 3), surgical site infection (SSI) (n = 1), cellulitis (n = 1), and hematoma (n = 1). The overall reoperation rate was 23.8%. Implant malposition occurred in 3 of the 8 (38%) of subfascial implant placement patients. Complications requiring revision surgery were higher for subfascial implants 37.5% vs 15.4% for submuscular. CONCLUSIONS: Biceps augmentation with a solid silicone implant can increase upper arm volume and correct asymmetry and deformity resulting from muscle injury. Submuscular biceps implant placement is recommended over subfascial insertion to avoid implant malposition.

Revision Buttock Implantation: Indications, Procedures, and Recommendations.

BACKGROUND: Buttock implant studies have focused largely on safety, efficacy, and complication rates of primary surgery. The revision buttock implant surgical experience has to date not been published. METHODS: A retrospective chart review was conducted to collect data from patients who underwent revision buttock implantation surgery performed by the author over a 12-year period from June of 2003 through December of 2015. Inclusion criteria consisted of any patient for whom an implant was either removed and replaced, exchanged, or repositioned after prior buttock implant surgery. The indications, types of procedures, and results of revision buttock implantation surgery based on the author's experience are described. RESULTS: Forty-three patients (32 women and 11 men) underwent revision buttock implantation surgery. Indications included replacement after removal (n = 18), asymmetry (n = 16), and size change (n = 9). Revision buttock implantation procedures included implant removal (n = 24), implant replacement (n = 19), implant exchange (n = 18), capsulotomy (n = 6), site change (n = 5), and capsulorrhaphy (n = 1). The overall complication rate was 17.8 percent. Complications were highest after unilateral implant replacement (n = 5). CONCLUSIONS: Revision buttock implantation is often necessary to correct or improve the results of primary buttock augmentation. Implants should be removed as soon as diagnosed in case of infection to reduce additional complications and permit successful reimplantation. Surgeons performing buttock implant surgery should be aware of the common indications, surgical procedures, and complications associated with revision buttock implantation surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Aesthetic Surgery of the Buttocks Using Implants: Practice-Based Recommendations.

The demand for gluteal enhancement has increased rapidly in the past few years. In this Continuing Medical Education (CME) article, the evaluation, surgical planning, operative technique, and management of potential complications of gluteal augmentation using solid silicone implants are discussed. Practice-based recommendations are presented along with a review of the scientific literature. The intramuscular and subfascial technique is described along with a discussion of the advantages and disadvantages of each approach. Guidelines for implant selection, placement, and revisional procedures are presented along with recommendations for maximizing successful outcomes.

Buttock augmentation with silicone implants: a multicenter survey review of 2226 patients.

BACKGROUND: Enhancement of buttock volume with gluteal silicone implants has been performed by surgeons for over 30 years, but no studies have examined complication rates or outcomes of more than single-surgeon experiences. Numerous technical differences in how gluteal augmentation surgery with implants is performed also exist, and to date, surgeon preferences for implant plane, incisional access, implant type, and drain use have not been quantified. METHODS: A 10-question survey was sent to 83 targeted members of the American Society of Plastic Surgeons requesting information about number of cases performed, duration of surgeon experience, implant placement plane and incisional access, implant type, length of typical surgery, use of drains and antibiotic irrigation solution, surgeon satisfaction and surgeon assessment of patient satisfaction, and number of complications experienced. RESULTS: Nineteen respondents (25 percent response rate) provided data on 2226 patients. Thirteen respondents (68.4 percent) favored the intramuscular plane of dissection over the subfascial plane. Preference for incisional access was nearly equally divided between a single incision in the gluteal cleft (10 respondents) and two incisions separated within the cleft (nine respondents). The total number of complications reported was 848 (38.1 percent). CONCLUSIONS: Gluteal augmentation with silicone implants has gained popularity in the last decade. Despite this, no previous studies have examined multisurgeon experiences with this procedure to determine complication rates or surgeon technical preferences. The authors present data from a survey sent to experienced gluteal augmentation surgeons. Advances in technique and implant options are needed to improve complication rates experienced with this procedure.

Buttock augmentation with solid silicone implants.

BACKGROUND: Buttock augmentation with solid silicone implants has become an increasingly popular procedure in the United States, but few outcomes studies have been undertaken to evaluate its safety and efficacy. OBJECTIVE: The author examines the results of buttock augmentation with solid silicone implants in his private practice. METHODS: A retrospective chart review was conducted of 200 consecutive patients who underwent bilateral buttock augmentation with a total of 400 solid silicone implants over an eight-year period from June 2001 through August 2009. Implants were placed in the subfascial position in 154 patients and in the intramuscular position in 46 patients. Most intramuscular implant placements occurred early in the series, before the author refined his technique. Data from all patients were analyzed to determine the rate of complication, need for surgical revision, and aesthetic outcome. RESULTS: Twenty-six men and 174 women were included in the study. The mean duration of follow-up was three years. The overall reoperation rate for these patients was 13% (n = 26). Seroma formation was the most common complication, occurring in 28% (n = 56) of patients. The infection rate was 6.5% for both subfascial and intramuscular implants (n = 13). The implant infection rate was 3.8% (15 of the 400 implants). Hematoma formation occurred in 2% (n = four) of patients. Wound dehiscence occurred in 1.5% (n = three) of patients. Capsular contracture was noted in 1% (n = two) of patients. Data showed that additional aesthetic procedures at the time of buttock augmentation did not affect the complication rate. In terms of patient satisfaction, patients with intramuscular implants complained more often about a lack of inferior gluteal fullness. CONCLUSION: Buttock augmentation with solid silicone implants is a safe and satisfying procedure for both patient and surgeon. The most common complication in this series was seroma formation, which was treated with serial aspiration in most cases. Gluteal implants were successfully placed in either the subfascial or intramuscular position with no significant difference in complication rate, but subfascial implant placement can produce better aesthetic results in patients requiring inferior gluteal fullness.