GLADI: Gluteal Adipose Implant. A new technique for the reshaping of the gluteal-trochanteric region

The author describes a new technique of fat grafting of the buttocks, GLADI (Gluteal Adipose Implant) based on Coleman procedure, associated with the lipoplasty of the gluteal-trochanteric region in order to improve harmony of the lower limbs. 132 patients were treated by this technique with very good results, no major complication, and a durable increase of the gluteal region in 125 (94.7%) of them. GLADI technique is a valid alternative to silicone implantations and offers durable improvements in gluteal shape without the need of additional surgery or the risk of implant rupture.     

Beautiful buttocks: characteristics and surgical techniques

The authors describe four characteristics that determine attractive buttocks in addition to the balanced anatomical dimensions of the maximal point of gluteal projection. Based on this information, defects of the gluteal region can be classified into five types.The most appropriate size and shape of gluteal implants and the proper surgical technique for gluteal augmentation can be chosen by first identifying the buttock type ofa patient. The proposed method of buttock classification helps achieve a gluteal contour that closely matches the standard of beauty.     

Intramuscular gluteal augmentation technique

Gluteal augmentation with the intramuscular approach produces very good aesthetic results and, when properly performed, has a low incidence of complications. Using the intramuscular tissue plane ensures that implants are naturally positioned. In addition, larger implants may be used than with the submuscular technique, which many patients request. Of all possible gluteal implant placement options, the intramuscular position provides the greatest amount of implant coverage and pads the implant with muscle tissue above and below as well as along the inferior edge.     

Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling

Background

Free flap breast reconstruction is an option widely sought in postmastectomy breast reconstruction. However, the volume of autologous tissue from the patient is often not sufficient for symmetrical reconstruction. In these cases, flaps can be used in combination with implants or autologous fat injections to augment volume and achieve shape, symmetry, and contour.

Methods

A retrospective chart review was performed on patients who underwent postmastectomy free flap reconstruction with secondary augmentation using autologous fat grafting or implant from 2008 to 2011.

Results

Twenty-four patients (39 breasts) received further augmentation of autologous tissue reconstruction during this period. Sixteen patients (26 breasts) had fat graft augmentation only, four patients (eight breasts) had implant augmentation only, and three patients (five breasts) had both procedures. Among patients who had fat grafting, operative intervention was required twice for fat necrosis. Contrastingly, of patients who received implants, one patient required operative intervention for implant malpositioning. These differences were not significant (P?=?0.57). The group with both fat grafting and implant augmentation had significantly higher aesthetic scores regarding overall appearance, contour, and volume, but not projection, than the group with fat grafting only and the group with implant only.

Conclusions

Autologous fat grafting offers several contouring aesthetic advantages, including selectively augmenting areas of hollowness to improve contour and maximize symmetry. However, implant augmentation generally allows for a larger increase in projection in a single procedure, with similar rates of postaugmentation complications. Use of both autologous fat grafting and implant augmentation may allow for superior aesthetic results. Level of Evidence: Level IV, therapeutic study.     

Gluteal augmentation surgery: indications and surgical management.

The most common surgical techniques performed for gluteal augmentation employ the use of implants and a combination of liposuction/lipo-injection procedures. We review the major literature concerning this subject with emphasis on gluteal implants, the various indications, surgical techniques and complications are discussed and we present some of our cases. Contour reconstruction, indications such as malformation, asymmetry, trauma and radiotherapy may require custom-made or regular implants, liposuction or lipo-injection procedures and sometimes free flaps. Gluteal implants for aesthetic purposes are widely used, particularly in South America, are easy to perform with a high success rate, whereas lipS200osuction and lipo-injection procedures require considerable experience in Coleman fat injection.     

Contouring of the gluteal region in women: enhancement and augmentation

Techniques for improving the appearance of the gluteal region are important elements in body contouring. In all cultures and communities, this aspect of the physique holds a special place among the elements comprising the ideals of physical beauty. Recent studies described the aesthetics of the gluteal region in terms of shape, volume, and projection. Accumulation of fat at the supragluteal, lower paralumbar, infragluteal, and/or trochanteric areas often disturbs the natural shape of the buttocks. The problem is accentuated by the lack of lateral projection. This study was designed to find a method for contouring of the gluteal region. This method is based on the enhancement of the shape by liposculpture of the areas around the buttocks, and lipoinjection to achieve the volume and projection. Between July 2008 and December 2009, the study included 40 female patients complaining of disfigurement of the gluteal region. With 1 year follow-up period, 36 patients showed high satisfaction with the results. Pre- and postoperative perimeters of the gluteal regions showed good improvement in proportion and projection. The study concluded that liposuction of the areas around the buttocks could enhance the shape of the gluteal region. Lipoinjection could add a balanced shape, size, and projection. A pleasing gluteal appearance could be achieved by the combination of enhancement and augmentation.     

吸脂并脂肪充填联合腹臀部整形人体轮廓塑形术

目的：探讨采用多项手术方法（吸脂术、颗粒脂肪注射隆胸、丰臀术,腹壁整形及提臀术等）行体形重塑。方法：对172例就医者在肿胀麻醉下采用注射器吸脂,脂肪颗粒注射隆胸、丰臀,腹壁整形和提臀术。根据患者具体情况采用2种以上的手术组合。结果：随访1～5年,无并发症,切口瘢痕隐蔽,效果满意。结论：多种手术方法联合应用,是较为满意及可取的手术方法。     

Late Intracapsular Seroma in Subfascial Buttock Augmentation: A Case Report

Late intracapsular seroma and hematoma have been described frequently as a complication of breast augmentation surgery. However, there are few reports of late intracapsular seroma in buttock augmentation. Textured and polyurethane implants have been used for subfascial enlargement of the buttocks. In this article, the authors report a large late intracapsular bilateral seroma caused by a retrofascial polyurethane-covered implant used for buttock augmentation: 1,200 ml on one side and 300 ml on the other. This patient’s intracapsular seroma was of sudden onset 2 years and 6 months after surgery, and apparently had no relation to any trauma, use of medication, or physical exercise. Local tissues, including the gluteal fascia, were distended such that the implant was replaced inside the muscle and there was no relapse of the seroma. Late intracapsular hematomas or seromas from implants for buttock and breast augmentation may have the same etiology, and textured implants seem to be involved. All the reports on the matter are associated with textured implants. Any late seroma or hematoma caused by a smooth implant is related to an additional factor that may be considered as the etiologic agent. Further studies aimed at a large-scale assessment of the cause and actual incidence of late seromas and hematomas from textured implants are required.     

Gluteal compartment syndrome following posterior cruciate ligament repair

Compartment syndrome is a rare but important complication which may occur following injury or surgery to the lower limb. We present a case of contralateral gluteal compartment syndrome following arthroscopic posterior cruciate ligament repair.In order to gain a greater understanding of this complication, we undertook a limited study to investigate the effect of patient position on gluteal compartment pressures.Three volunteers were positioned in such a way as to recreate the intra-operative position of the patient described. Gluteal compartment pressures were calculated by placing weighing scales under each buttock and measuring the surface area over which the weight was distributed.Mean pressures exerted on the gluteal compartment of the non-operated leg were significantly higher (mean=44 mmHg) than those of the operated leg (mean=24 mmHg). The difference was significant with P<0.001.This limited study has shown that care should be taken when positioning patients on an operating table to reduce the risk of compartment syndrome. Factors that should be taken into account include mean diastolic pressure, length of operation and the surface area in contact with the operating table.     

Correction of deep gluteal depression by autologous fat grafting

In the past, the traditional method of contouring the iliac crest and lateral femoral areas has been liposuction or the surgical removal of the bulges. Unfortunately, this method fails to correct the deep gluteal depression juxtaposed at these two sites. Since we use autologous fat grafts to correct contouring deficiencies elsewhere, it seems logical to investigate whether this technique is applicable to correcting this deformity. We have performed autologous fat grafting to the gluteal depression on 12 patients who underwent lipoplasty of the iliac crest and lateral femoral sites. The longest followup was one year. We have found that this method corrects the deep gluteal depression and yields an improved aesthetic contour. This article describes the technique, addresses the problems encountered, and shows postoperative results.Presented at the 60th Annual Scientific Meeting in Seattle, Washington, September 22, 1991     

Classification system for gluteal evaluation

The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping and augmentation. This phenomenon is reflected in statistics collected by the American Society for Aesthetic Plastic Surgery,which demonstrate a 533% increase in gluteal augmentation between 2002 and 2003. Increasing patient demand has necessitated a more structured approach to evaluation of gluteal anatomy and the development of surgical procedures to enhance its beauty. The proposed classification system for gluteal contouring focuses on evaluating and identifying the different frame types, the different gluteal muscle types, and the relationship between the muscle and the frame. Finally, a ptosis classification system is presented.     

Percutaneous angioplasty of the superior gluteal artery for buttock claudication: a report of seven cases and literature review

BACKGROUND: Buttock claudication due to stenosis or occlusion of the superior gluteal artery is infrequent. The recent development of noninvasive gluteal duplex scanning, combined with aortoiliac angiography using oblique projections and the availability of low-profile devices for percutaneous transluminal angioplasty (PTA), led us to review our recent experience concerning the diagnosis and mid-term results of PTA for superior gluteal artery stenosis or occlusion. METHODS: The files of all patients who had been treated in our department by PTA for superior gluteal artery stenosis or occlusion with buttock claudication were analyzed retrospectively, and any associated arterial lesions, morbidity, restenosis, or recurrent buttock claudication were noted. Outcomes were compared with published reports. RESULTS: Retrospective review identified six patients (5 men, 1 woman; mean age, 64 years) with seven cases of buttock claudication (1 bilateral localization) who had undergone PTA within the past 2 years. There was no case of isolated buttock claudication. Buttock claudication was associated with impotence, thigh claudication, or calf claudication in seven cases. Gluteal duplex scans were performed for three of the patients diagnosed with two stenoses and one occlusion. Aortoiliac angiography revealed five superior gluteal artery stenoses and two occlusions. PTA without stenting was successful in all cases, without morbidity or mortality. During a mean follow-up of 13 months, restenosis occurred in one patient. A repeat PTA without stenting was successful, with resolution of the buttock claudication. CONCLUSIONS: Buttock claudication due to superior gluteal artery stenosis is probably underestimated when gluteal duplex scanning and aortoiliac angiography with oblique projections are not performed. PTA gives good results, and the procedure can be repeated should restenosis occur.     

Body Contouring with Solid Silicone Implants

Background  Body-contouring implants are becoming increasingly popular and more accepted and requested for aesthetic purposes. These implants must be placed in a safe and reproducible plane of anatomic dissection for a successful long-term outcome. Poor implant placement techniques result in greater complications such as asymmetry, implant migration, capsular contracture, and infection. This article discusses (1) the history and the evolution of body-contouring implants, (2) the different techniques and dissection planes in which to put the implants in the calf, gluteal, pectoral, and triceps/biceps areas, and (3) the complications associated with the different implantation techniques. Methods  The different anatomical areas that have been treated with solid silicone implants are the gluteus, pectoral, calf, deltoids, biceps, triceps, and trapezium. Results  Determining the ideal plane for implant placement is the most important surgical goal for satisfactory aesthetic results. Conclusion  Aesthetic contouring of the chest, back, arms, buttocks, and calf can be done safely with solid silicone implants. Proper pocket dissection and location are paramount to successful implant placement and decreased complications.     

Sitting on a gold mine: optimal autologous reconstruction of a significant cosmetic contour defect of the buttock using a deep inferior epigastric artery perforator free flap

The options for reconstruction of soft tissue defects of the buttock include custom prosthetic implants and autologous tissue transfer: fat transfer, local flaps, pedicled flaps and free flaps. Optimal reconstruction involves replacement of like-with-like tissue, sufficient padding and adequate contouring. We report a case of a female patient presenting with a significant cosmetic contour defect of her left buttock following previous excision of a malignant fibrous histiocytoma. The patient had autologous buttock reconstruction using a deep inferior epigastric artery perforator free flap with an excellent result. To our knowledge a deep inferior epigastric artery perforator free flap has not previously been described to reconstruct the buttock.     

Calf,buttock, and pectoral implants

Breast, chin, and other facial implants are common and accepted approaches to body and facial contouring problems, but calf, buttock, and male pectoral implant surgeries are rare in most plastic surgery practices. Aesthetic Surgery Journal invited Adrien E. Aiache, MD; Lloyd N. Carlsen, MD; and practice associates Hugo Amezcua, MD, and Rafael Vergera, MD, to address some common questions about those procedures. Here are their responses to questions posed by “Comparing Notes”.     

A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps

Background  

Gluteal ptosis may result from sagging of redundant skin and fat below the infragluteal fold. The correction of gluteal ptosis and the definition of gluteal prominence can be obtained by several gluteal lifting techniques. We present a new technique to correct gluteal ptosis using deepithelialized dermal flaps.     

Autologous Gluteal Lipograft

In the past 25 years, several different techniques of lipoinjection have been developed. The authors performed a prospective study to evaluate the patient satisfaction and the rate of complications after an autologous gluteal lipograft among 351 patients during January 2002 and January 2008. All the patients included in the study requested gluteal augmentation and were candidates for the procedure. Overall satisfaction with body appearance after gluteal fat augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was made at follow-up times of 12 and 24 months. The total amount of clean adipose tissue transplanted to the buttocks varied from 100 to 900 ml. In nine cases, liponecrosis was treated by aspiration with a large-bore needle connected to a 20-ml syringe, performed as an outpatient procedure. Infection of the grafted area also occurred for four patients and was treated by incision drainage and use of antibiotics. Of the 21 patients who expressed the desire of further gluteal augmentation, 16 had one more session of gluteal fat grafting. The remaining five patients did not have enough donor area and instead received gluteal silicone implants. At 12 months, 70% reported that their appearance after gluteal fat augmentation was “very good” to “excellent,” and 23% responded that their appearance was “good.” Only 7% of the patients thought their appearance was less than good. At 24 months, 66% reported that their appearance after gluteal fat augmentation was “very good” (36%) to “excellent” (30%), and 27% responded that their appearance was “good.” However, 7% of the patients continued to think that their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 4.9 years. The key to successful gluteal fat grafting is familiarity with the technique, knowledge of the gluteal topography, and understanding of the patient’s goals. With experience, the surgeon can predict the amount of volume needing to be grafted to produce the desired result. Although the aim of every surgeon is to produce the desired augmentation of the gluteal region by autologous fat grafting in one stage, the patient should be advised that a secondary procedure may be needed to accomplish the desired result.     

Autoprosthesis buttock augmentation during lower body lift

With the increasing popularity of bariatric surgery, patients with multiple body contour deformities have become more common in plastic surgery practice. Most of the deformities involving the abdomen, thighs, and buttocks can be effectively corrected with belt lipectomy and lower body lift. A common problem with this procedure is postoperative loss of gluteal projection and resulting flattened buttock contour, which is directly proportional to the extent of lower body lift achieved. The use of local myocutaneous flaps to provide coverage for the lumbosacral defects is a common plastic surgery procedure. The authors have used these techniques to create an autologous buttock implant for additional projection during a lower body lift. A local myocutaneous flap originating within the regularly excised supragluteal tissue is rotated caudally to function as an autologous buttock implant. This flap has reliable circulation, can be custom designed for each patient, requires minimal additional operating time, and allows the creation of more than one flap if necessary. This article describes the results of this procedure used for 20 consecutive women. There were no major complications, and the most common minor complications included delayed wound healing and local hardness in the area, suggesting fat necrosis, which resolved without intervention in a few months. High patient satisfaction combined with a low complication rate suggests that this reliable, versatile technique nicely complements the lower body lift procedure.