Gluteal implants used to replace lost buttock fat
Simon Collins, HIV i-Base
One of the posters presented at the workshop provided details of implants used to correct buttock lipoatrophy in seven women treated at University of Barcelona. The surgeon, Dr Fontdevila has treated HIV-related lipoatrophy for over four years, predominantly using autologous fat transfer to correct facial lipoatrophy, with approximately 60% of procedures carried out in the plastic surgery department in HIV-positive individuals.
Buttock augmentation is inherently more difficult and more complicated to correct for two main reasons: the area to be filled is much larger than other areas affected by lipoatrophy, and that an implant in this area is subjected to significant daily stress and consequently a higher risk of migration or breakage. Very few studies have reported on successful buttock correction in patients with HIV, although earlier lipodystophy workshops have sometimes included experimental approaches – usually using high volume fillers in small numbers of patients.
The Spanish researchers use soft silicone implants manufactured by Silimed in Brazil and distributed in Europe by Polytech Silimed, Germany. Company literature says the implants consist of a highly resilient silicone elastomer filled with a highly cross-linked silicone gel so that even in case of a rupture the gel would not leak. Round implants were used for women with Grade 1 or 2 lipoatrophy and larger oval implants for women with Grade 3 fat loss. It is significant that in this procedure, the implants are inserted in intramuscular pockets, in order to minimise any chance of migration. The muscle fibre is used to hold and seal the implants. However this is a painful procedure and patients are advised that they should allow for at least one month for pain to subside and before they are able to walk normally. Non-HIV buttock augmentation insert implants under, not inside the muscle.
The only major complication reported occurred in the patient with the most severe atrophy, where a hip prosthesis migrated to the gluteal pocket, requiring surgical repositioning.
The study reported that all women were satisfied with the results, but some were worried then by the contrast between the treated area and the extreme thinness of their legs and thighs.
Although lost buttocks can be distressing, and can include physical discomfort, this procedure is likely to only appeal to a minority of people. From a safety perspective, there is concern that the trauma experienced by normal activity will require the implants to degrade, requiring replacement sooner than similar implants used for breast augmentation. This is estimated at every 8-10 years for buttock implants, with current follow-up protocol requiring monitoring for degradation by MRI scan after 5 years.
Patient support email discussion lists routinely include posts about the discomfort and psychological distress associated with losing buttock fat. It is important to follow any procedures being reported, though with the limited data on current options, for most people the invasive nature of this procedure, combined with the uncertainty of the results, will probably encourage a conservative approach towards this treatment.
Severe loss of buttock fat, especially if compounded by muscle loss, can certainly have a negative impact on quality of life, but the difficulty and pain associated with normal sitting is possibly still best countered by using padded underwear or a cushion.
Fontdevila J et al. Surgical treatment of the buttocks and hip atrophy in feminine lipodystrophic patients. 7th Intl Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 13-16 November 2005, Dublin, Ireland. Abstract 41.