COSMETIC Buttock Augmentation with Silicone Implants: A Multicenter Survey Review of 2226 Patients M. Mark Mofid, M.D. Background: Enhancement of buttock volume with gluteal silicone implants Raul Gonzalez, M.D. has been performed by surgeons for over 30 years, but no studies have examined Jose´ Abel de la Pen˜a, M.D. complication rates or outcomes of more than single-surgeon experiences. Nu- Constantino G. Mendieta, merous technical differences in how gluteal augmentation surgery with implants M.D. is performed also exist, and to date, surgeon preferences for implant plane, Douglas M. Senderoff, M.D. incisional access, implant type, and drain use have not been quantified. Soheila Jorjani, Ph.D. Methods: A 10-question survey was sent to 83 targeted members of the American La Jolla and San Marcos, Calif.; Sa˜o Society of Plastic Surgeons requesting information about number of cases per- Paulo, Brazil; Huizquilucan, Mexico; formed, duration of surgeon experience, implant placement plane and inci- Miami, Fla.; and New York, N.Y. sional access, implant type, length of typical surgery, use of drains and antibiotic irrigation solution, surgeon satisfaction and surgeon assessment of patient sat- isfaction, 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 respon- dents) 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 popular- ity in the last decade. Despite this, no previous studies have examined multi- surgeon 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 im- plant options are needed to improve complication rates experienced with this procedure. (Plast. Reconstr. Surg. 131: 897, 2013.) he enhancement of buttock volume with sil- Surgeons, 1149 buttock augmentation proce- icone gluteal implants has rapidly gained in dures with implants were performed in 2011 by Tpopularity over the past decade. For many member surgeons, up from 542 procedures per- leaner patients, gluteal augmentation with autol- formed in 2005, the first year with recorded data ogous fat grafting is not an option secondary to the for this procedure.1 Gluteal augmentation surgery lack of donor tissue. In those patients, gluteal suffers from a reputation of high rates of compli- augmentation with silicone implants is the only cations, including infection and the need for im- remaining option to increase buttock volume. plant removal, despite the fact that there have According to the American Society of Plastic been no studies published to date to support this impression. Though many studies have docu- mented complication and satisfaction rates for im- From the Division of Plastic Surgery, University of California San Diego; Division of Plastic Surgery, University of Ribeira˜o Preto; private practice; and College of Business Administra- tion, California State University. Recipient of the Ralph Millard Award for most outstanding Disclosure: Dr. Gonzalez receives royalties from the presentation, 39th Annual Meeting of the Canadian Society sale of his book, Buttocks Reshaping (Rio de Janeiro, for Aesthetic Plastic Surgery, Que´bec City, Que´bec, Canada, Brazil: Indexa Editora Ltda; 2006). Dr. Mendieta September 15, 2012. receives royalties from the sale of his book, The Art of Received for publication August 8, 2012; accepted September Gluteal Sculpting (St. Louis, Mo.: Quality Medical 17, 2012. Publications, 2011). The remaining authors have no Copyright ©2013 by the American Society of Plastic Surgeons other relevant financial disclosures. DOI: 10.1097/PRS.0b013e3182818ec0 www.PRSJournal.com 897 Plastic and Reconstructive Surgery • April 2013 plant procedures of the breast and face, there have RESULTS been no studies to date documenting more than There were 19 respondents (25 percent re- single-author experiences of buttock augmenta- sponse rate) providing information on 2226 pa- tion procedures with silicone implants. tients. The number of patients reported by sur- The desire to add increasing volume to the geons ranged from five to 1240 (average, 117.2 buttocks to improve the female body has undoubt- patients; median, 35 patients). Thirteen respon- edly been shaped by popular culture. In the dents (68.4 percent) favored the intramuscular United States, immigration and the changing eth- plane of dissection over the subfascial plane. The nic balance may be tilting the perception of the majority of respondents (n ϭ 12, 63.2 percent) ideal waist to hip ratio in favor of more pro- had more than 5 years of experience with gluteal nounced curves and greater definition.2 The ma- augmentation procedures using implants. The av- jority of published reports in the plastic surgery erage duration of surgery was less than 3 hours for literature to date on gluteal augmentation with 15 respondents (79 percent). Antibiotic irrigation silicone implants come from the South and Cen- solutions were used by 84.2 percent of respon- tral American experience with this procedure.3 dents (n ϭ 16) to bathe implants or to irrigate the By way of anonymous survey, we sought to dissection pocket. Preference for incisional access determine relative complications and to tabulate was nearly equally divided between a single inci- data on surgeon preference with respect to im- sion in the gluteal cleft (10 respondents) and two plant plane (subfascial versus intramuscular), in- incisions separated within the cleft (nine respon- cision used (single versus double), drain use, and dents). The use of drains was identified by 84.2 textured versus smooth implants. We also tabu- percent of respondents (n ϭ 16), with the majority lated data on all complications, including seroma using drains for 4 or more days (63.2 percent, n ϭ formation, hematoma, infection, chronic pain, 12). The majority of surgeons (n ϭ 12, 63.2 per- sciatic nerve symptoms, implant palpability, cap- cent) used textured implants, and the majority of sular contracture, need for revisionary surgery, surgeons responding used AART (Reno, Nev.) im- and implant removal. plants (n ϭ 10, 52.6 percent). The average rating for surgeon satisfaction METHODS with the procedure was 7.3/10, and the average A 10-question survey (Table 1) was designed rating for surgeon assessment of patient satisfac- on SurveyMonkey (Palo Alto, Calif.), and sent tion was 8.5/10. The total number of complica- electronically to 83 members of the American So- tions reported was 848 (38.1 percent). The most ciety of Plastic Surgeons, including nine interna- common complication reported was incisional tional members known to perform gluteal aug- separation resulting in a wound (n ϭ 175, 7.9 mentation with silicone implants. Anonymous percent). Other common complications included responses were received from 19 respondents (25 need for implant revision (n ϭ 111; 5.0 percent), percent response rate) providing information on acute prolonged pain lasting for more than 12 2226 gluteal augmentation procedures. Included weeks postoperatively (n ϭ 93, 4.2 percent), within the survey were questions designed to de- chronic seromas (n ϭ 82, 3.7 percent), minor termine surgeon preference for implant plane infection not requiring implant removal (n ϭ 80, (subfascial versus submuscular), duration of sur- 3.6 percent), and excessive implant palpability geon experience in years, incision preference (n ϭ 75, 3.4 percent). Implant removal was nec- (one- versus two-incision technique), and manu- essary in 3.8 percent of patients (n ϭ 85) for facturer of implants used, as well as all complica- reasons including major infection, chronic pain, tions experienced. and chronic seromas. Data were entered into an Excel spreadsheet (Microsoft, Seattle, Wash.), and statistical analysis was performed using IBM SPSS Statistics software DISCUSSION (IBM Corp., Armonk, N.Y.). Descriptive statistics There is a relative paucity of outcomes data were used to summarize and calculate means and and surgical technique data published on the sub- standard deviations. Pairwise analysis of propor- ject of gluteal augmentation with silicone im- tions of various complications using different pro- plants. The procedure itself suffers from a repu- cedures described above was calculated and tested tation for having exceedingly high complication for significance. To determine relations and cor- rates, despite the fact that no data have been pub- relations between variables in the study, chi-square lished to date to corroborate this impression and Kendall’s tau coefficients were calculated. among plastic surgeons. In fact, the incidence of 898 Volume 131, Number 4 • Buttock Augmentation with Silicone Table 1. Buttock Augmentation Survey (19 ؍ Question Answer Choices Responses (n 1. How many buttock augmentation Range, 5–1240 procedures have you performed Average, 117.2 using silicone implants? SD, 277.84 Median, 35 Total (all respondents), 2226 2. In what dissection plane do you Subfascial 6 (31.6%) perform the majority of silicone Intramuscular 13 (68.4%) buttock augmentation procedures? 3. How long have you been performing 1–2 years 2 (10.5%) buttock augmentation surgery with 3–5 years 5 (26.3%) silicone implants? Ͼ5 years 12 (63.2%) 4. How long does buttock augmentation Յ2 hours 9 (47.4%) surgery typically take you to perform? 2–3 hours 6 (31.6%) 3–4 hours 4 (21.1%) Ն4 hours 0 5. Do you use antibiotic irrigation Yes 16 (84.2%) solutions to bathe your implants or to No 3 (15.8%) irrigate the dissection pocket? 6. Do you typically perform buttock One incision 10 (52.6%) augmentation surgery using silicone Two incisions 9 (47.4%) implants by placing a single incision within the vertical cleft of the buttocks, or do you use two incisions within the cleft? 7.