Split gluteal muscle flap for autoprosthesis buttock augmentation.

BACKGROUND: Several flaps have been described to provide autologous augmentation to the gluteal area. Since the authors' original description of a dermal fat flap for buttock augmentation during lower body lift in 2005, the procedure has been refined considerably. Unique to previously described flaps, the technique results in maximum projection of the buttock at its midportion. A decrease in fatty necrosis and greater mobility has been achieved by transitioning to a split gluteal musculocutaneous flap. METHODS: In a retrospective review from January of 2004 to August of 2010, 200 patients, aged 24 to 57 years, underwent autologous buttock augmentation. The last 50 patients of the series underwent an incorporation of a split section of gluteus maximus muscle. Patients were followed for 6 months to 4 years. RESULTS: Of the 200 patients, 30 had the buttock flap as an isolated buttock lift and augmentation; the remainder of the procedures were performed in conjunction with a circumferential body lift. Incorporation of the split gluteus maximus muscle facilitated the rotation of the flap caudally and increased the vascular supply to the flap. Ten percent of the patients had minor complications, which included small areas of delayed wound healing and partial fat necrosis of the dermal flaps. In the group with split musculocutaneous flaps, there was no fatty necrosis. Results were maintained over time. CONCLUSIONS: This is a reliable, versatile, and efficient flap for autologous buttock augmentation. With recent modifications, the incidence of fatty necrosis has been substantially decreased. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.