Intraoperative ultrasonography to guide intramuscular buttock implants.

Ultrasonography (US) is useful for a number of purposes. Intraoperative ultrasound (IOUS) provides better spatial and contrast resolution of the anatomical structures and organs than any other imaging method and is used mainly to identify nonpalpable lesions, guide surgical procedures, and stage local tumor disease. 1 In plastic surgery, US is not commonly used as a transoperatory guide, although there are reports of IOUS having been used to guide the dissecting instrument for surgical treatment of fibrous tissue gynecomastia through mini-incisions. 2 The objective of this letter is to describe the application of IOUS as a guide for intramuscular undermining during gluteal implant surgery. Over the past 12 months, we have performed nine intramuscular gluteal implant surgeries with this method. The primary goal of implementing IOUS during these procedures was to prove that the anatomic structures and points that act as a reference in our XYZ technique 3-5 were reliable sites—that is, we sought to prove that by following the reference points, the surgeon is in fact on the right path to dissecting a plane within the muscle at the desired depth. We feel that this goal has been fully achieved. Although this forum is not appropriate for a full discussion of the data generated in this nine-patient series and we plan to address the reliability of the XYZ technique in a separate publication, the study led us to believe that the use of IOUS might be of great help to other surgeons in undermining inside the muscle at an adequate plane. In this way, it can provide surgeons (beginners or experienced) with a method for safer intramuscular dissection, and it can also act as a useful tool for teaching intramus-cular gluteal implant surgery. This is of great relevance since one of the drawbacks of gluteal implant surgery is that if the dissection plane within the gluteus maximus (GM) muscle is incorrectly bisected, the implant may be visible postoperatively, which is an unacceptable complication in this procedure. Specifically, with regard to the GM, the surgeon must ensure that bisection occurs exactly at the muscle's mid-thickness, so that the portion anterior to the implant and the one posterior to it are of the same thickness, rendering a sort of implant-muscle " sandwich, " which we actually refer to as the " sandwich plane. " This prevents a situation in which unequal thickness in the muscle division could result in atrophy of …