Capsular Contracture and Chronic Intractable Pain in Gluteal Implant Augmentation

INTRODUCTION: As interest and popularity of buttock augmentation increases, postoperative complications also increases. The complications are inflammation, infection, asymmetry, and contracture, and so on. However, there are few mentions regarding chronic pain after the gluteal augmentation surgery. We present the case with chronic pain and sensory changes since gluteal augmentation using implants and even after removing implants. METHODS: A woman had undergone augmentation gluteoplasty with silicone implants (Silimed, Rio de Janeiro, Brasil) in the subfascial plane. Severe pain started immediately after the surgery and was sustained for several months. She got rid of the implants from the pain then, but the symptom was not subsided. The painkillers and neuroblocking procedures did not work. Nine years have passed, the patient came to our clinic due to intractable pain destroying the routine. The symptom was severe (NRS 9) and like burning and sharp shooting pain. It radiated from the hip to the lower back and was aggravated by the lying and sitting position. In addition to that, hypoesthesia was combined. In magnetic resonance imaging (MRI), the remaining capsules over the gluteus maximus muscle were verified; abnormal findings, however, were not observed within the areas of the sciatic nerves. The total capsulectomies were carried out at both side. The diluted triamcinolone injections were performed on the buttock with scar contracture, partly. Since 8 months after the capsulectomy, the pain almost disappeared (NRS < 2), and she needed no more painkillers and got back to regular social activity. DISCUSSION: This interconnection of capsular contracture and prolonged severe pain in buttock augmentation has not been presented ever. We had initially assumed neurogenic cause from the peripheral nerve injuries relevant to buttock augmentation or sciatic nerve-related in this patient. However, capsular contracture was turned out to be the leading cause of severe long-term pain after implant insertion surgery. Even if capsular contracture rarely occurs after gluteal implant augmentation surgery, caution would be needed regarding capsular contracture and relevant chronic neuropathic pain, which can be agonizing to the patient.