Ten years ago, somewhere overseas, a surgeon put two implants in her buttocks. This summer she sat in my office and asked me to take them out and put fat in their place, in one surgery, and go home.
I understand the appeal. One anesthetic, one recovery, one bill.
The problem is not the fat. It is the hole.
“When the patient wants the implants out, I usually will stage it before doing the fat transfer. We can do a little bit of fat transfer at the same time, but it really depends where the implant was placed. If it was placed over the muscle, then a fat transfer will be difficult, as a lot of the fat will go into the pocket and die, becoming necrotic and forming a firm nodule.”
Transferred fat is a graft. It has no blood supply of its own for the first several days and survives only by sitting against living tissue that can feed it. An implant pocket is a cavity lined with scar. Put fat in it and you have filled a space, not planted anything.
“If the implant is under the muscle, then there is a good layer of fatty tissue where we can transplant the fat using the BBL method and ultrasound. But a lot of times, when we remove the implant, a large divot is left at the apex where the implant was, and it will require further fat transfer. Sometimes it can be done with alloClae, which is a donor fat graft. More often than not, the procedure needs to be staged.”
So two operations, three to six months apart.
“The main reason is we want the swelling to settle down, the implant pocket to close off, and the patient to recover physically before undergoing general anesthesia again.”
What happens in the meantime is less dramatic than patients have been led to expect. The capsule comes out if it is thick, stays if it is paper-thin and taking it would mean cutting muscle, and comes out entirely if the implant has ruptured. The muscle itself is not sewn back together in layers, whatever another office has told you.
“If you try to put a bunch of sutures in muscle, because there’s no fascia in the middle of the muscle, it just rips open.”
It heals on its own, in about five days, because it is muscle and muscle has blood. A drain stays in for roughly a week so the pocket collapses instead of filling with fluid.
“I can tell you in the buttock, in more than a thousand cases, I’ve never had a hematoma in the buttock. It just behaves different.”
Then, months later, the fat. And here the news is good.
“Fat survival is the same in a buttock that has had an implant, still has an implant, or has had an implant removed. We always overfill when we do a fat transfer, because we know we’re only going to get about fifty to eighty percent of the fat to survive and integrate.”
The wait was never about the fat. It was about turning a cavity back into tissue.
One more thing, because every patient who asks about conversion has read that buttock implants are a disaster.
“I don’t think they have fallen out of favor. I think they have always had somewhat of a negative reputation. This is because many physicians place the implants over the muscle, which over time creates sagging, and you can see a double butt deformity. You can feel the implants. You can even flip them, as you can see in some YouTube videos.
“Placing them inside the muscle does avoid a lot of these complications. It is a more difficult surgery, but the few surgeons that perform it have decreased complication rates when done correctly.”
Hers, as it happened, were in the muscle, which is why I could tell her the removal would be uncomplicated and that she would have options afterward. Most of the stories that scare patients off are about implants that were never put there.
That is not an argument against implants. It is an argument about where they go.
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