DYING FOR A BIGGER BUTT
Women who aren’t happy with the size and shape of their buttocks may wonder if plastic surgery is for them. They may have heard about the Brazilian butt lift — a transfer of fat from one part of the body through liposuction to the butt, where a surgeon fills and shapes the entire backside.
Some may be considering a trip to Florida, New York or California, where surgeons do high numbers of the procedure. But they might not have heard about the urgent warning of deaths from the procedure that was issued in mid-July by a task force of five societies representing plastic surgeons from around the world.
“Let patients know this is probably the riskiest operation right now,” said UPMC plastic surgeon J. Peter Rubin, one of three co-chairs of the Gluteal Fat Grafting Task Force.
The warning said the mortality rate from the butt lift is estimated to be as high as one in 3,000, “greater than any other cosmetic surgery.” It said in 2017 there were three deaths in Florida alone.
The warning was followed by an Aug. 2 report that identified common factors in autopsy reports of patients who died and also made guidelines for surgeons to reduce the chance of complications from the butt lift.
“We’re taking aggressive action to get to the root cause, to work together to make procedures safer,” Dr. Rubin said.
At UPMC, he serves as co-director of its Aesthetic Plastic Surgery Center. His research subjects include scar complications, fat metabolism and liposuction safety.
The task force said the deaths had these things in common: fat found in the gluteal (buttocks) muscles, fat found under the layer of those muscles, damage to either of the two major gluteal, veins and “massive fat emboli” — blockages of fat globules — in the heart and/or lungs.
Several factors made the procedure more risky and others helped protect the patient’s safety. Among the guidelines for surgeons: Keep the fat injection to under the skin but over the muscle (the subcutaneous layer). None of the deaths occurred when the fat was found only in that layer.
Doctors were warned to avoid the veins in the buttock region and the sciatic nerve, and to avoid using bendable cannulas (thin tubes used to inject the fat into the buttocks), to give the surgeon more control over them.
Similar recommendations came out of a 2017 task force report from the Aesthetic Surgery Education and Research Foundation. It surveyed plastic surgeons worldwide and 692 responded, reporting 198,857 cases of gluteal fat grafting. Over their careers, the surgeons reported 32 deaths from a pulmonary fat embolism — a fatty blockage in a lung artery, obstructing blood flow to the lungs. There were also 103 cases of nonfatal fat embolism. A higher rate of these fatty blockages was associated with a technique of injecting fat into deep muscle.
Fat grafting in general is very safe, according to Pittsburgh plastic surgeon Leo McCafferty, but the large blood vessels in the gluteal muscle pose a danger because if fat is injected into them, the particles can travel to the lungs, causing a potentially fatal obstruction.
Dr. McCafferty is a past president of the American Society for Aesthetic Plastic Surgery, a partner in the five-group task force. He said the popularity of buttock-augmentation skyrocketed in 2013 and ranks about 12th in popularity.
“Though celebrities such as Kim Kardashian, Beyonce and Jennifer Lopez may have started the trend of emphasizing the