Paris, France.
From the Department of Plastic and Reconstructive Surgery, Groupe Hospitalier Paris Saint Joseph.
Plast Reconstr Surg. 2018 Mar;141(3):625-636. doi: 10.1097/PRS.0000000000004178.
An often-neglected part of the lower body lift procedure is the gluteal region. The objective of this study was to classify massive weight loss patients undergoing a body lift procedure and provide a safe, standardized approach for gluteal augmentation.
A retrospective review of all body lift procedures performed between January of 2012 and January of 2017 was conducted. Patients undergoing a lower body lift with or without gluteal augmentation were included for analysis. Patients were classified as follows: type I, minimal lower and upper back fat and deflated buttock; type II, substantial lower back fat, minimal upper back fat, and deflated buttock; type III, substantial lower and upper back fat and deflated buttock; and type IV, good buttock projection. Type I patients had gluteal implants, type II patients had autologous flap augmentation, type III patients had gluteal lipofilling, and type IV patients did not have any gluteal augmentation.
Two hundred eighty patients were included for analysis. Two hundred thirty-eight underwent concomitant gluteal augmentation (85 percent): 213 had autologous flaps (76 percent), 13 had gluteal implants (5 percent), and 12 had large-volume lipofilling (4 percent). Forty-two patients underwent a body lift with no gluteal augmentation (15 percent). Gluteal augmentation did not increase the rate of complications. In both groups, no skin necrosis, venous thrombosis, or pulmonary embolism was reported. Patients who had a sleeve gastrectomy had significantly lower odds of complications compared with gastric bypass (OR, 0.45; p = 0.017).
A standardized algorithmic approach for gluteal augmentation may optimize the result without increasing the complication rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
下身提升术常被忽视的部分是臀部区域。本研究的目的是对接受身体提升术的大量体重减轻患者进行分类，并提供一种安全、标准化的臀部增大方法。
对 2012 年 1 月至 2017 年 1 月期间进行的所有身体提升术进行回顾性分析。纳入接受下身提升术（伴或不伴臀部增大）的患者进行分析。患者分类如下：I 型，下背部和上背部脂肪较少，臀部凹陷；II 型，下背部脂肪较多，上背部脂肪较少，臀部凹陷；III 型，下背部和上背部脂肪较多，臀部凹陷；IV 型，臀部投影良好。I 型患者接受臀部植入物，II 型患者接受自体皮瓣增大，III 型患者接受臀部脂肪填充，IV 型患者不进行任何臀部增大。
共纳入 280 例患者进行分析。238 例患者同时进行了臀部增大（85%）：213 例行自体皮瓣（76%），13 例行臀部植入物（5%），12 例行大容量脂肪填充（4%）。42 例患者进行了不伴臀部增大的身体提升术（15%）。臀部增大并未增加并发症发生率。在两组中，均未报告皮肤坏死、静脉血栓形成或肺栓塞。与胃旁路术相比，行袖状胃切除术的患者并发症发生率显著降低（OR，0.45；p=0.017）。
标准化的臀部增大算法可能优化结果而不增加并发症发生率。
临床问题/证据水平：治疗性，III 级。
