Gluteal Implant Augmentation - Comparing Outcomes between Single and Two Incision Techniques.
Buttock implants continue to gain popularity as an alternative option to fat grafting for buttock volume augmentation, and according to ASPS, had the largest year over year rise of any cosmetic procedure between 2019-2020, increasing by 22% (1). A meta analysis of intramuscular gluteal implants demonstrated that the overall complication rate was approximately 19% (2). The purpose of this study was to compare a single surgeon’s experience with regard to complication rates between single and two incision techniques for gluteal implant placement.
Methods/Technique:
We performed a retrospective chart review of gluteal implant operations done by a single surgeon since moving to his new practice location between October 2018 and August 2022. The first 100 cases completed at the new location were selected, as were the last 100 to allow for comparison of both techniques after changing from a single to two incision technique in September 2020. Charts were reviewed for technique used as well as all postoperative complications. Complications included reoperation with implant removal, implant malposition requiring revision, and delayed wound healing without reoperation. There were 19 charts that were missing follow-up information and were thus excluded.
Statistical analysis was performed using the software package SPSS Statistics V 28.0.1.1 (IBM). Statistical comparisons between the two incision techniques were carried out using the independent sample t-test for numerical variables (equal variances were not assumed) and the Fisher’s Exact test for categorical variables. A reported p-value < 0.05 was considered a statistically significant difference.
The surgical technique is described here. The patient is prepped with betadine from the thighs to the lower back. A betadine soaked laparotomy sponge is placed into the anus in order to isolate the anus from the surgical field. Our single incision technique is performed by deepithelialization of a 7 x 1.5 cm vertical portion of skin in the native cleft and dissecting in an angled fashion through the subcutaneous fat to the gluteal fascia. Fascia is left in place and blunt dissection within the muscle is performed after splitting the muscle along the direction of its fibers. Once the implants are seated, the muscle is closed and multiple plication sutures are used to close the remaining dead space by reapproximating the subcutaneous soft tissue down to the muscle. The remaining incision is closed in the usual fashion in multiple layers.
Two incision technique includes a 7 cm linear incision off the native cleft on each side that begins 1cm superior to the anal verge. The technique is the same for each side thereafter. No deepithelialization is performed. We then used fat harvested from the low back to graft the patient’s lateral hip dips as necessary on a case by case basis.
Results/Complications:
There were no major significant differences in the baseline characteristics between the patients who underwent single incision technique compared to the two incision technique. The average volume of fat grafted in the single incision group was 97 cc, which was significantly more than the volume grafted in the two incision group at 35 cc. The average BMI was 22.9 in the single incision group and 22.8 in the double incision group.
Total complication rate was 30.6% in the single incision group and 12.8% in the two incision group. Infection rate was 0.7% in the single incision group and there were no infections in the two incision group. Delayed wound healing rate was 17.9% in the single incision group and 10.6% in the two incision group. Implant exposure requiring reoperation was 1.5% in the single incision group and there were no implant exposures in the two incision group. Implant malposition requiring reoperation was 10.4% in the single incision group and 2.1% in the single incision group. The odds ratio of developing at least one complication was 0.42 (0.19, 0.92) when comparing two incisions to one incision.
Conclusion:
We found a statistically lower overall complication rate with the two incision technique. Overall, our most common complication in both incision groups was delayed wound healing and superficial dehiscence, which responded in the majority of cases to conservative wound care. Our complication rates using single incision were similar to those reported in the literature while the complication rates with the two incision technique are lower. This data supports our practice of using two incision technique for gluteal implant augmentation.