Buttock Implant Asymmetry

Q: Dr. Eppley, I’m concerned about my right buttock implant. I had large buttock implants (625ccs) placed above the muscle about one year ago. My right buttock implant seems to be lower than my left and it seems to continue dropping. As shown in the attached pictures the left is the perfect buttock while the right is not so perfect. What are my options to correct this without another surgery or spending thousands of dollars?

A: Like all implant asymmetry issues anywhere on the body or face, there are never any non-surgical solutions to their repositioning or adjustment. But to provide a more wholesome perspective, let’s review why you have what you have and what you would do if the concept of another surgery or economics were not an impediment to the desire for improvement.

Buttocks implants in the subfascial plane (above the muscle) have a known propensity to potentially drop as they heal and settle. This is quite unlike intramuscular buttock implants which stay locked in a high pocket because of their tight muscular confinement. At 625cc implant size, this was never an option for you since the largest implant in the intramuscular pocket at your height would be about 350cc to 400c maximum. In the subfascial plane, all the surgeon can do is place them in what appears to be a high pocket knowing that they will settle. Why one implant eventually settles lower than the other one, like in your case, is unknown and unpredictable. Why it may do so even at a late period after surgery is also unknown. The size of the implants may have something to do with it but then the one buttock implant is fine….so clearly size alone is not the sole driving factor. Whether any further dropping may occur is also not known but there is a limit as to how how low it can go and I suspect you have likely reached it.

Correction of buttock implant asymmetry, unlike that of breast implants, is neither easy or assured. Repositioning of a low breast implant, for example, is comparatively easier since the access point (the incision) is at a convenient position on the underside of the breast and the pocket can be sutured upward. Such is not the case with buttock implants where the access point is from above. The implant would have to be removed and the pocket attempted to be sutured from far away through a small incision and the implant re-inserted. This is a very difficult surgery and the retention of the pocket elevation very unlikely given that one has to sit on it at some point after surgery. While it can be done, success with upward buttock implant respositioning is usually very low.

While buttock implant asymmetry is not a desired aesthetic outcome, the risks of revisional surgery may outweigh any effort in that regard. Besides the low probability of success, entering a healed implant pocket always induces the potential risk of infection. Should infection occur, which is always more likely in subfascial vs. intramuscular pockets, the aesthetic outcome would be disastrous with loss of the implant.

Putting all of this in perspective, living with some buttock implant asymmetry may be the only economic choice, it may also be the best medical decision also.

Dr. Barry Eppley

Indianapolis, Indiana