Revision Buttock Implantation: Indications, Procedures, and Recommendations

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We commend Dr. Senderoff for his last work entitled “Revision Buttock Implantation: Indications, Procedures, and Recommendations,” published in the February of 2017 issue of the Journal.1 To a large extent, he has already contributed to our understanding of implant-based gluteal augmentation, with fundamental contributions regarding the U.S. experience of using solid silicone implants. In this article, the author analyzed retrospectively a series of 43 patients of both sexes to identify the motivations to seek revision implantation surgery and proposed appropriate techniques for secondary gluteoplasty. The main indications included replacement after removal, asymmetry, and size change, whereas the revision procedures included implant removal, implant replacement, implant exchange, capsulotomy, site change, and capsulorrhaphy.
Dr. Senderoff also observed that correcting or improving the results of primary buttock augmentation is often required, although he did not report his own reoperation rate and did not discuss the reoperation rates as they were reported in the literature. We believe that this aspect merits being specifically and further explored, also considering the tremendous interest from plastic surgeons worldwide to extend their knowledge on a subject that has become a very hot topic.2–4
In a recent comprehensive review that analyzed all of the existing literature without restriction of time or language of publication, we quantified the conditions associated by Dr. Senderoff to revision surgery in 4871 treated patients.2 Overall, the need for implant revision was specifically rated by the authors as equal to 3.1 percent, whereas the three main indications listed by Dr. Senderoff were reported as follows: implant removal, 1.9 percent; asymmetry, 1.3 percent; and dissatisfaction with the final volume, 0.3 percent. If we also include in the analysis all the other conditions that were classified as possibly responsible for secondary gluteoplasty, they were rated as follows: infection, 3.2 percent; implant palpability, 1.7 percent; implant displacement including rotation, 1 percent; hematoma, 0.8 percent; capsular contracture, 0.7 percent; and implant rupture, 0.1 percent.
Moreover, very interestingly, it has to be noted that Dr. Senderoff has reported an overall complication rate after secondary gluteoplasty equal to 17.8 percent, significantly lower than that reported after primary gluteoplasty, which in our comprehensive review was equal to 30.5 percent. A lower rate (21.6 percent) has been previously calculated by Sinno et al. in a review that included the English literature only.5 This may possibly be explained by the large experience of Dr. Senderoff in performing an operation that still requires a high qualification and tremendous skill to ensure safety and successful outcomes, as is well demonstrated by the high overall complication rates. This is required even more when performing autologous fat grafting gluteal augmentation, which is extremely popular for primary gluteoplasty and recommended by Dr. Senderoff for tertiary gluteoplasty after two attempts with prosthesis. A profound knowledge of the anatomical topography of the region, especially with regard to the vascular supply, is indeed necessary in this case to avoid serious and potentially lethal complications such as fat embolism.
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