Augmentation buttock-pexy using autologous tissue following massive weight loss

Abstract

Body contouring after massive weight loss has become more popular as the rate of gastric bypasses and other bariatric surgeries increases. After bariatric surgery, the buttocks not only tend to become loose and ptotic but also lose their natural fullness. To improve buttock fullness in postbariatric patients, a technique was developed for autologous tissue buttock augmentation during excisional contouring. A medially based flap of subcutaneous tissue was transposed as a supramuscular autologous "implant" as part of a belt lipectomy or lower body lift. The flap was composed of subcutaneous tissue, and dermis if desired, and was extended laterally to the length needed to approximately reach the infragluteal fold, and then rotated. The buttock skin and subcutaneous tissue were advanced superiorly and rotated medially to tighten the buttocks, lateral thigh, and posterior thigh. The technique was performed in 62 patients, with consistent durable results after follow-up as long as 4 years. The most common complications were wound dehiscence and persistent seromas, which primarily occurred early in our series. Although the seroma rate declined after fibrin sealant was used in the procedure, the series was too small to determine whether the sealant or other technical factors were responsible for the lowered rate. A procedure that combined an abdominal body lift with augmentation buttock-pexy using autologous tissue achieved a pleasing and durable buttock contour. We present this technique as a reliable method to improve the cosmetic results of postbariatric surgery body contouring.