What size and shape implants?
Doctor Answers 8
What size implant to get
Your ideal implant size is determined by your buttocks cheek width which is independent of your height and weight; in order to determine this size you would need an examination and measurement of your buttocks cheek. I like to leave 2cm medially in order avoid implant extrusion, and avoid the lateral cheek dimple where the implant edge would be palpable; please see examples below.
Buttock implant sizing
The largest stock buttock implant currently available in the USA is a 690cc round implant. For the implant brand i prefer and my Stanton Anatomic Oval implants, the largest is 600cc. Indeed custom implants can be ordered larger, not only at a premium price but at a premium risk for most patients'. Unlike breast implants which are placed under the very expandable tissue of the breast and half of the pectoral major muscle, buttock implants should only be placed under or at least within the largest strongest muscle of the body, the gluteus maximus muscle, which is not nearly as expandable or forgiving. Thus most patients simply do not have a large enough native buttock muscle to fit an implant much over 500 ccs', without leading to significant complication such as wound breakdown/opening &/or implant exposure...necessitating removal. If a patient wants larger implants, 9-12 months after the initial implants have settled in to place and the muscle relaxed/stretched, then a second operation can be performed to replace them (similar to the process of going bigger with breast implants). Be aware, the "subfascial" space that is sometimes talked about is not a real potential space to place a buttock implant. It is essentially the same as a subcutaneous pocket (ie on top of the muscle/under the skin and fat layer only) and therefore should be avoided at all costs. Some of those sought after video-vixen and celeb-types (without mentioning names) with cartoonish bottoms could have either gotten extremely lucky with a huge oversized implant (very unlikely if properly placed under the muscle), had a very large volume of filler injected such as silicone, PMMA, Sculptra, or hydrogel - all NOT recommended because of high risk of severe infections, migration and/or hardening over time, and even deadly consequences in rare but significant instances (if mistakenly injected into the blood stream); and/or have been genetically "blessed" - although quite unlikely.
I generally do not recommend fat grafting at the same time as placing buttock implants because of a significantly increased risk of infection. For fat to survive it must be grafted into muscle, however that is also where the implant sits. Thus, if fat it injected into the implant or implant pocket then it will die and almost assuredly get infected - necessitating removal of the implant as well. Fat transfer later on must be done very carefully and cautiously, preferably by the original surgeon, for the very same reasons as above. In both instances, the risk/reward ratio is very high (meaning high risk to very low potential reward) because over 80% of the fat is likely to melt away yielding very small gains in augmentation.
Nonetheless, buttock implants are a proven safe and effective method of buttock augmentation as long as the recommendations of a board certified plastic surgeon specialist are adhered to.
Glad to help.
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Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Physical Evaluation with a Plastic Surgeon
Thank you for sharing the photos.
Deciding the volume for implants based on your heigh and weight is not only one of the facts to take into consideration.
To decide a volume of an implant, any kind of implant, the doctor has to personally evaluate the patient, because you cannot place an implant that your muscle won't tolerate.
I invite you to go into consultation with a certified plastic surgeon to decide whats the best option for you.
Best of luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.