| BODY CONTOURING | PEER-REVIEW
Figure 12 45-year- old patient. (A, C) Pre- and (B, D)
postoperative view
after gynaecomastia treatment plus
pectotal implants
(190 cc) and biceps implants (110 cc oval)
Key points Silicone implants are
experience lateral implants tend to displace upwardly, owing to the lack of space when two implants are placed. Most complications are related to minor compression of sensitive nerves that are self-limited. The worst complication that one might see is compartment syndrome, because it might produce muscular necrosis and Volkmann syndrome, with severe aesthetic and functional sequelae. The author has not experienced any case of seroma
for any implant, other than pectoral augmentation. A small amount of periprosthetic fluid is normal and is usually found at areas where the implant is slightly wrinkled. In a previous article1
, the author reported not a
single case of seroma in 18 patients with pectoral enhancements for aesthetic reasons. In the following ten patients, however, there have been four cases. This was related to a change in implant manufacturing. In the author’s opinion, seroma was caused by rubbing of the implant surface with the muscle. For this reason, Polytech changed the shell of pectoral implants to microtextured. Silimed has smooth implants available. Hodgkinson7 reported 30% of seroma cases and claimed to reduce that incidence by careful dissection and the use of NSAIDs. Pereira et al8
reported the occurrence of three seromas out of 16 patients with calf augmentation.
Conclusions To ensure success with muscular enhancement using implants, the author suggests following these broad recommendations: Choose an implant that properly fits the pocket and muscle size. Avoid using an oversized implant
Choose a microtextured or smooth implant Give a thorough explanation to the patient of the pros and cons of the procedure as well as insisting on resting during postoperative weeks (5–7 weeks)
Do not detach the muscle boundaries. Keep in mind the anatomy of the muscle.
Declaration of interest None Figures 1–12 © Jesús Benito-Ruiz
very helpful for aesthetic (body contouring) and reconstructive indications in men
Implant selection and technique are very dependent on surgeon knowledge (anatomy) and experience
With good planning,
good results can be achieved and
complications can be avoided
Explain to the patient
the pros and cons of the procedures very thoroughly
The size of the implant depends on the anatomy and the size of the pocket
Do not adhere only to patient wishes
References
1. Benito-Ruiz J, Raigosa JM, Manzano-Surroca M, Salvador L. Male chest enhancement: pectoral implants. Aesthetic Plast Surg 2008; 32(1): 101–4
2. Vergara R, Amezcua H. Intramuscular gluteal implants: 15 years’ experience. Aesthetic Surg J 2003; 23(2): 86–91
3. Benito-Ruiz J. Buttock and hip enhancement with implants. In: Shiffman MA. ed, Cosmetic Surgery, Art and Techniques. Springer-Verlag 2013
4. Glicenstein J. Correction of amyotrophies of the limbs with silicone prosthesis inclusions. Rev Bras Cir 1979; 69: 117
5. Carlsen LN. Calf augmentation – a preliminary report. Ann Plast Surg 1979; 2(6): 508–10
6. Kalixto MA, Vergara R. Submuscular calf implants. Aesthetic Plast Surg 2003; 27(2): 135–8
7. Hodgkinson DJ. Contour restoration of the upper limb using solid silicone implants. Aesthetic Plast Surg 2006; 30(1): 53–8
8. Pereira LH, Nicaretta B, Sterodimas A. Bilateral calf augmentation for aesthetic purposes. Aesthetic Plast Surg 2012; 36(2): 295–302
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