Macroscopic and Microscopic Proof of Long-Term Survival of Gluteal Fat Transplantation

Sir: The adipose tissue seems to be a nearly ideal material for use as a permanent soft-tissue substitute. In 1989, after observing Fournier performing fat tissue transplantation onto the lower limbs to correct sequelae of poliomyelitis, we introduced to our practice the concept of autologous fat transplantation for gluteal, trochanteric, and inner aspect of the thigh fat enhancement.1 A 32-year-old woman presented with complaints of having “no buttocks,” which made her “unattractive” (Fig. 1, left). A composite body-contouring procedure was offered to her, commencing with liposuction of the back, flanks, and abdomen. Gluteal fat transplantation was performed. The following volumes were placed in one procedure: right gluteointramuscular, 180 ml; left gluteointramuscular, 190 ml; right gluteal subcutaneous space, 50 ml; left gluteal subcutaneous space, 60 ml; right subgluteal sulcus, 40 ml; and left subgluteal sulcus, 30 ml. Figure 1, center, shows the result at 5 years after the procedure.Fig. 1.: (Left) Preoperative view of a 32-year-old patient’s gluteal area. (Center) Postoperative view 5 years after the gluteal fat transplantation. (Right) Postoperative view 1 year after insertion of the gluteal silicone implant.Although the patient declared her satisfaction, she expressed the desire to further augment her gluteal area. After evaluation of the availability of autologous fat, it was decided that to meet her objective it would be better to insert gluteal silicone implants. A 250-cc quartz-type gluteal silicone implant was inserted bilaterally. This implant is produced by Silimed Comércio de Produtos Médico-Hospitalares Ltda, in Brazil. Intraoperatively and when the intramuscular plane was created for positioning of the implants, several “lipoma”-like tissues were observed inside the muscle (Fig. 2). Histological examination reported the presence of “lipoma-like formations” attached to the gluteal muscle. The postoperative result 1 year after the insertion of the gluteal silicone implant is shown Figure 1, right.Fig. 2.: The “lipoma-like formations” in the intramuscular plane.The macroscopic observation and the histological examination in this particular case confirm, for the first time in clinical practice, what published experimental animal studies have shown: that the intramuscular survival and revascularization of injected fat is a fact.2–4 In 2000, a 7-year experience of the senior author in the grafting of aspirated fat in the gluteal region of 233 patients was presented. In 90 percent of cases, the results were considered satisfactory.5 Although in this specific case the long-term survival of gluteal fat grafting was proven clinically and histologically, a small percentage of patients may need to undergo further fat augmentation or insertion of a gluteal silicone implant to achieve the desired result. Luiz Haroldo Pereira, M.D. Department of Plastic Surgery Luiz Haroldo Clinic Rio de Janeiro, Brazil Aris Sterodimas, M.D., M.Sc. Department of Plastic Surgery Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute Rio de Janeiro, Brazil