Right Butt Cheek Hard and Lumpy After Fat Grafting

Question

I had a buttocks fat grafting done in Jan 2009. My left butt cheek healed nicely but my right one is hard and lumpy like a rock. It is almost the size of my palm. I massage it but seems like its not working. Why is it like this? Is it dead clumpy fats? How do I get this corrected?

Armando Soto, MD, FACS · Answer

Hi there-
In the Brazilian Butt Lift technique, fat is removed from one area of the body and grafted into the buttocks to improve shape and projection. This fat is dependent on the diffusion of nutrients from the surrounding tissues for the time it takes for new blood vessels to form that will nourish the new tissue in the long term.
If some of the grafted fat cells don't get enough blood flow, they will either be absorbed by the body (which should be expected to some extent with this technique), or will become a firm mass called fat necrosis. It sounds like this is what you have experienced (although of course there is no way to know for sure without an examination).
If this is in fact fat necrosis, there are several options available to you- you should discuss these with your surgeon, but generally the area will soften over time (although it sometimes takes more than a few months).
Talk to your surgeon about the options- usually time takes care of the problem, but understanding the problem and the options will probably make you feel a lot better.

Jaime S. Schwartz, MD, FACS · Answer

A good candidate has enough fat available for transfer in the procedure. The amount of fat that can be transferred in a BBL depends on how much fat the patient has to harvest and the amount of space there is to move the fat into. It is recommended for the patient to have a BMI of 30 or less. If you are too thin, a Brazilian Butt Lift may not be possible.

Farbod Esmailian, MD · Answer

The hard area is likely fat cells that did not take or become vascularized. At this point I would simply massage as much as possible. It will take some time and it should resolve over time with the massage. There is possibility that it may not resolve with time. But I would give it atleast a year before start worrying about it.

	 

	Good luck.

Ron Hazani, MD, FACS · Answer

A physical examination is needed to determine what is wrong with the graft. Please follow up with your doctor as these issues require the attention of a plastic surgeon.

Pat Pazmino, MD, FACS · Answer

From the description that you have given, it is possible that you may have a fat necrosis in that area. This is one of the possible complications after a Brazilian Butt lift. The most important thing to do is to follow up with your plastic surgeon, show them the area, inform them of your concerns, and ask for their advice. They may recommend an aspiration or biopsy of the area or other modalities. Also let a plastic surgeon know if the size of this area has changed as well.

	For more information on Brazilian butt lifts or butt augmentation, please schedule an iConsult or visit us online.

Samir Shureih, MD · Answer

This is probably FAT NECROSIS.
If it has not gone by now then you will need surgery to remove the fat that has not taken, This can be done with ultrasound liposuction. This will leave you with minimal if any scar. Wait till healed then do another fat grafting to equalize you.

Talmage J. Raine, MD, FACS (retired) · Answer

If one cheek feels perfectly fine and the other has a hard lump it is most likely a hematoma or some fat necrosis.  There is no good way to resove these surgically and you may want to massage and apply moderate heat.  If you are numb there do not apply heat for fear of burning yourself.  Over a long period of time you should see gradual improvement.

	Best,

	Talmage J. Raine MD FACS

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