Gluteal implants has a long list and high rate of complications.That’s why most plastic surgeons don’t offer the procedure.Biofilms are caused by slow growing bacteria cod staphylococcus epidermidis. The bacteria cannot be treated with regular antibiotics and it’s usually very difficult to detect.It’s a very slow growing bacteria that causes chronic inflammation which causes recurrent capsulelar contractions and other problems around various forms of implants that get contaminated during surgery. biofilms can happen around vascular implants and breast implants or any foreign body placed that gets contaminated.It’s very difficult to confirm the diagnosis so it is usually a diagnosis based on exclusions.If a woman has breast implants that gets recurrent capsular contractions no matter how many times the capsule is removed it is most likely due to a bio film with this slow growing bacteria. it’s the number one reason some women fail and breast augmentations because of recurrent capsulelar contractions.Typically removing the foreign body is the number one and best way to reduce the problem. Ideally a complete capsulectomy should also be done to avoid any potential spaces that conserve as protected areas for the bacteria to grow.There is no way to know if the capsular contraction what are the bacteria causing it is the underlying cause of pain. you are not a good candidate for further surgery though ideally a full capsulectomy should’ve probably been done at the time of implant removal if it wasn’t.A full capsselectomy with placement of drains is the best way to minimize any chronic fluid pockets remaining they could harbor the bacterium causing biofilm.Going back in after implant removal to attempt a capsulectomy is probably not a worthy pursuit.I suggest if you have not done so already you have a consultation with a pain specialist.They can do a work up and hopefully confirm where the pain is coming from. it’s common to have pain in the lower back, buttocks or thighs from undiagnosed spinal pathology causing pressure on spinal nerves creating referred pain in different areas. when that’s the case thigh and buttocks pain can sometimes be relieved by doing steroid injections at the points of nerve compression as they leave the spinal cord.There isn’t really much a plastic surgeon can do for you at this point unless you want to address the shape and contour of your buttocks which is most likely going to be challenging.Patients should be well educated before deciding on having cosmetic surgical procedures and this is especially true for high-risk procedures like gluteal implants.I said it earlier and I will continue to say that there is a good reason why must plastic surgeons don’t offer this procedure.In the end surgeons are responsible for the outcome of their surgeries but likewise patients are responsible for choosing to have surgery and the decision of which provider to use.Generally I recommend all patients avoid gluteal implants and if they’re going to have them then select surgeons who have exceptionally high degrees of experience and only place implants intramuscularly.Using anatomic implants that fit correctly in the intramuscular space seems to have the lowest chance of complications and undesirable side effects.Placing the implants above the muscle or using excessively large implants increases complication rates.Best,Mats Hagstrom MD
