What Is The Best Technique For Successful Results with Buttock Implants?

Q: What is the best buttock implant augmentation technique? I have heard differing viewpoints about inside the muscle and on top of the muscle.

A: Just like breast implants which can be placed under the muscle or on top of it, buttock implants share a similar two pocket location approach. (although intramuscular not under the muscle is where buttock implants are placed) Whenever there are two ways to do any surgery and different surgeons either approach, that indicates that neither method is perfect. You then have to look at the different advantages and disadvantages to either approach and figure out which one matches your needs the best and which risk profile is more tolerable.

The arguments for the subfascial location for buttock implants is the following. This pocket location allows placement of the biggest implants with sizes up to 700ccs. It creates a nice ‘S’ curve by making the pocket up to the posterior iliac spine, where the gluteal muscles actually attach. It also has a faster recovery because the muscle fibers are not disrupted deep into the belly of the muscle. Its disadvantages are that it has a higher incidence of seroma formation, potential implant visibility (if you have little subcutaneous fat between the skin and the muscle) and a greater chance of implant displacement/rotation. (since there is less tissue resistance)

The arguments for the intramuscular location for buttock implants is the following. It provides a thicker more vascularized tissue pocket which lessens the risk of seroma formation, potential implant displacement and has less risk of tissue thinning over time between the implant and the overlying skin. Its disadvantages are that it is somewhat more technically difficult to perform, has a limitation to implant size that can be placed (350cc or less) and has a longer recovery.

When you put all this together you can see that it is not so simple as just one implant location is better than the other. You have to look at each patient and make a decision based on their goals, tolerance for recovery and their tissue qualities. For thin or small women that have little subcutaneous fat tissue, an intramuscular implant location is usually best. For larger women with thicker subcutaneous fat layers that want a larger buttock augmentation result, a subfascial location would be preferable

Regardless of buttock implant location, a very important element that affects the result is the strict adherence to postoperative instructions to avoid too aggressive early activities. This can increase the risk of incisional wound separation, seroma formation and implant displacement.

Dr. Barry Eppley

Indianapolis, Indiana