Q: Dr. Eppley, I am a plastic surgeon practicing in Slovakia. I recall that you place your buttock implants intramuscular…..I am seeing a patient soon interested in gluteal implants. If you have a moment I have a few questions for you since my experience was limited in buttock augmentation.
2. How long until you let your patients sit? Seems like a wide discrepancy in the literature.
3. I recall you using the incision technique according to Raul Gonzalez where the midline is depithelialized preserving the sacrocutaneous ligament….I will do the same.
4. How long until you let your patients sit on an airplane?
5. Do you place drains with the intramuscular approach?
6. How do you determine implant volume choice….do you use templates?
Thanks for your help!
A: Be aware that buttock implants are the hardest of all body implants to placed and when you do your first case you are likely to ask yourself why made you think it was a good idea to do this surgery. The other very important preoperative consideration is that the size of buttock implants that can be placed different dramatically from subfascial vs. intramuscular. You and the patient have to have a clear idea as to expectations. Intramuscular buttock implants will almost always be smaller than the patient wants, have a very long recovery and are very hard technically to do since there is no natural plane of of dissection. Subfascial buttock implants allow for much larger implant sizes, have a somewhat quicker recovery and are technically much easier to do. But to answer your intramuscular buttock implants questions:
- The duckbill dissector to which you refer is not absolutely essential as a wide malleable restractor can similarly be used. At at $850 for the instrument it really becomes non-essential.
- I let patients discomfort determine when they can sit…as they eventually have to do some sitting for certain functions
- Re-establishment of the sacrocutaneous ligament is essential in closure of the intergluteal incision.
- Same as answer #2
- There is no reason to use drains in the intramuscular buttock implant technique.
- With intramuscular buttock implants you are never going to get an implant in and satisfactorily covered with muscle over it that is bigger than 330cc. It just can’t be done. Your implant options are going to be either 270, 300 or 330cc. When in doubt choose the smaller implant size.
Dr. Barry Eppley