In response to questions raised by Dr. Swanson in his letter to the Journal, we submit the following. Although we found several of his points to be only tangentially relevant to the subject matter within the original article and others to be fully explained within the article itself, we have elected to respond to both. It is understood on the basis of communication with Dr. Swanson that he has had a limited and unsuccessful experience with gluteal augmentation with silicone implants.1 The authors do not advocate the performance of this procedure without adequate training and advance study. Resources to assist the surgeon interested in learning this technique are available through both textbooks and teaching courses at national meetings of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Success with this procedure is highly dependent on both technique and perioperative care, as would be the case with nearly all procedures that plastic surgeons perform.
As we state in the first paragraph of the original article, leaner patients that desire the addition of greater volume to the gluteal region are not candidates for fat grafting procedures.2 Dr. Swanson’s recommendation that we stop trying to improve on gluteal augmentation techniques using implants and limit ourselves presumably as a specialty to suction lipectomy and fat grafting procedures ignores the obvious. Patients without adequate autologous donor fat to achieve the results desired in gluteal volume are not candidates for fat grafting procedures.
With respect to his concerns about the scar location within the intergluteal cleft and that analogous breast scars would not be tolerated, even when wound separation has occurred, these typically heal remarkably well and in most cases so well within the cleft that, to most untrained eyes, they are hardly even identifiable as scars. The need for scar revision after gluteal augmentation is so rare that we did not even identify the occurrence within the study. Scars associated with other aesthetic procedures of the face, breast, and trunk seem to be of much greater significance than those associated with gluteal augmentation.
Procedural statistics available through our national societies are heavily reliant on surgeon participation. At this time, based on the relatively small numbers of cases reported by member surgeons of the American Society of Plastic Surgeons for buttock augmentation procedures, it is unlikely that small relative changes can be relied on entirely as indicative of overall popularity. The most recent statistical reporting available by the American Society for Aesthetic Plastic Surgery for 2012 reveals that more than 7000 buttock augmentation procedures (not stratified for implants versus fat grafting) were performed by member surgeons, representing an increase of 40 percent over 3 years.3 It is the impression of the surgeon authors of this study that buttock augmentation with silicone implants has increased significantly in popularity over the past 5 years.
The overall complication rate reported by this study of 38.1 percent should be interpreted relative to the complication rate associated with other aesthetic implant procedures. Breast augmentation is widely regarded as a safe procedure with a high patient satisfaction rate despite an even higher 45 percent complication rate studied over a 7-year period.4 To suggest that somehow breast augmentation surgery using implants should be an accepted procedure yet gluteal augmentation with implants should not seems an arbitrary judgment.
We believe that Dr. Swanson’s response misses the point of the study. The intent of the study was not to promote the procedure but to address physician preference and broadly identify complication rates. Decisions about whether an individual patient should be a candidate for the procedure should be determined by well-trained surgeons familiar with the body of literature on the subject and in the course of an informed consent discussion with the patient.
Dr. Gonzalez receives royalties from the sale of his book, Buttocks Reshaping (Rio de Janeiro, Brazil: Indexa Editora Ltda; 2006). Dr. Mendieta receives royalties from the sale of his book, The Art of Gluteal Sculpting (St. Louis, Mo.: Quality Medical; 2011). The remaining authors have no other relevant financial disclosures.
M. Mark Mofid, M.D.
Constantion G. Mendieta, M.D.
Douglas M. Senderoff, M.D.
Division of Plastic Surgery
University of California San Diego
San Diego, Calif.
1. Swanson E. Personal communication April 9, 2013
2. Mofid MM, Gonzalez R, de la Peña JA, Mendieta CG, Senderoff DM, Jorjani S. Buttock augmentation with silicone implants: A multicenter survey review of 2226 patients. Plast Reconstr Surg. 2013;131:897–901
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