Reply: The Lipo–Body Lift
It is true that the lack of buttock projection is found in a small number of type I massive weight loss patients on our classification before body lift. Projection is aggravated after surgery if no strategy is being developed to improve the projection. In our experience, few patients really want, and ask their surgeon for, a gluteal increase.
It is for this reason, and because flap or fat grafting was associated with postoperative complications, that we wanted to develop a less invasive and safer technique for buttock autoaugmentation.3 This technique is based on the extensive use of concomitant liposuction, which enables preservation of the connective tissue and partly the microvessels,4 without undermining the edge of the scar, after which wound closure is carried out by moving the tissues of the lower flap from outside to inside. Our autoaugmentation without flap makes it possible to reduce the operating time, which is a predictive risk factor for complication (see the reply to the letter of Dr. Dast et al.). In our opinion, we even think that associating the flap and fat grafting can be dangerous to buttock flap survival, with an increased risk of infection and cytosteatonecrosis.
To our knowledge, until now, only one retrospective study has reported patient satisfaction with or without buttock augmentation. Srivastava et al.5 demonstrate that although the postoperative complication rate is higher for the augmented patient (42.5 percent versus 19.7 percent; p = 0.012), patient satisfaction is not. Only the physician judged the result better in patients with a buttock augmentation (p = 0.032).
In conclusion, plastic surgeons have the option of not performing any autoaugmentation after a body lift. This allows simplifying the operative technique and reducing the complication rate without decreasing the satisfaction of these complex patients. The massive weight loss population offers a new challenge for body contouring, and we think that the lipo–body lift will take a useful place among the therapeutic techniques used in reconstructive strategies.