INTRODUCTION
According to the World Health Organization (WHO), “quality of life is an individual’s
perception of their position in life in the context of the culture and value systems
in which they live and concerning their goals, expectations, standards, and interests.
“ Even when the causes of psychological discomfort are small deformities or minor,
aesthetic flaws, these can cause a feeling of inferiority or a factor of emotional
conflict1.
The concept of female beauty has changed over the years, but the shape and size of
breasts and buttocks remain symbols of maximum femininity. Body exposure, especially
in the gluteal region, has led to an increased demand for augmentation gluteoplasty
surgery. This is due to better evaluation of the posterior contour and modern gluteoplasty
techniques2,3.
Augmentation gluteoplasty can be performed using autologous tissues specific to the
body (fat, dermal-fat flap, muscle flap) or artificial materials (implants, fillers),
combined or not4.
Autologous adipose tissue has been used to correct soft tissue defects since the beginning
of the last century. Its smooth and natural texture, available in sufficient quantities,
and potentially permanent integration make adipose tissue the ideal physiological
filling material5.
In the mid-1980s, the technique of liposuction by syringe was disseminated, which
standardized methods for collecting fat simply and safely, increasing the surgeon’s
interest in free fat transplantation6.
Gluteal fat grafting is an important alternative associated with the liposuction procedure,
improving the aesthetic result without injecting large volumes of fat7. This technique can be applied to a wide variety of patients and avoids complications
and risks intrinsic to the use of alloplastic materials, in addition to taking advantage
of interactions between adipose tissue grafts and the recipient site. It offers a
faster recovery period and fewer complications in the medium and long term compared
to the use of gluteal implants8.
However, when the result is unexpected in plastic surgery, regrets are frequent and
irrevocable1. Thus, due to the large number of plastic surgeries performed in the country, it
is common that some patients are not fully satisfied with the results obtained9.
Assessment instruments in cosmetic surgery are a vital factor in assessing patient
satisfaction with physical appearance. Appearance and satisfaction assessments are
necessary to assess the quality of life in various surgical interventions adequately10.
OBJECTIVE
The study aims to compare the pre- and postoperative quality of life concerning the
aesthetic appearance and the degree of satisfaction of patients who underwent subcutaneous
gluteal fat grafting.
METHOD
The research consists of a prospective study applying the gluteal evaluation questionnaire
in patients who underwent subcutaneous gluteal fat grafting from August to December
2019.
The project was approved by the Research Ethics Committee of Faculdade Evangélica
Mackenzie, in Curitiba-PR, on August 9, 2019, under number CAAE 18086719.6.0000.0103.
All surgeries were performed by the same plastic surgeon in hospitals/clinics in Curitiba
(PR).
The variables evaluated were age, body mass index (BMI), and comorbidities.
Inclusion criteria
Patients who underwent subcutaneous gluteal fat grafting were older than 18 and agreed
to the Free and Informed Consent Form (TCLE).
Exclusion criteria
Patients who refused to participate in the study.
Questionnaire for assessing the quality of life
The buttocks assessment questionnaire assessed the patient’s quality of life (Annex 1). This questionnaire was based on the Breast Evaluation Questionnaire (BEQ) and encompassed
three aspects: satisfaction, comfort, and importance, totaling 37 questions about
the appearance of the buttocks. The BEQ was originally developed in 2006 and comprised
55 questions related to satisfaction and comfort with the general appearance of the
breasts.
Responses are given on a five-point scale, with 1 being very dissatisfied or very
uncomfortable and 5 being very satisfied or very comfortable. The questionnaire comprises
three parts. The first part questions satisfaction with the buttocks’ size, shape,
and firmness in different situations: sexual, social, or professional activities.
The second part verifies the degree of comfort with the appearance of the buttocks
when fully dressed, in bathing suits or naked, being alone, with an intimate partner,
with men in general, women in your relationship, women not so intimate, or health
professionals. The third part contains two questions, the first asking them to rate
their level of satisfaction with the appearance of their buttocks for themselves,
their partner, parents, siblings, and friends.
The questionnaire was applied in two moments, in the pre- and postoperative consultations,
with the postoperative consultation taking place between 55 and 75 days after the
procedure. This time interval is necessary for the inflammatory process’s recovery
and local edema reduction, allowing a more accurate assessment of patient satisfaction.
The answers to the items in the questionnaire were filled out in a reserved place
so as not to embarrass the exposed data.
Statistical analysis
The statistical package Statgraphics Centurion XVI and Microsoft Excel were used for
the analyses. Student’s t-test was used for testing hypotheses since the calculated
scores fit the normal distribution. It was verified whether the mean of the calculated
scores was greater than zero, that is, whether the mean of the response scores was
better in the postoperative than in the preoperative period. For the tests, a significance
level of 0.05 was used.
RESULTS
Forty patients who underwent subcutaneous gluteal fat grafting were selected, 39 female
and only 1 male. The age of the patients ranged from 22 to 59 years, with a mean of
36.55 years and a median of 34 years.
Of these 40 patients, the BMI ranged from 20.77 to 35.76, with a mean of 27.38. No
patient was classified as having a BMI below the ideal weight, 8 (20.00%) patients
had normal weight, 24 (60.00%) were overweight, 7 (17.5%) had grade I obesity, 1 (2.5%)
had grade II obesity and none of the patients had grade III obesity.
Regarding the comorbidities of patients who underwent subcutaneous gluteal fat grafting
in this study, 21 (52.50%) had no disease. In contrast, 4 (10.00%) patients had varicose
veins, 4 (10.00%) had anemia, 4 (10.00%) were hypertensive, 2 (5.00%) patients had
thyroid disease, 2 (5.00%) had some type of psychiatric disorder, 2 (5.00%) had bronchitis,
1 (2.50%) patient was with asthma, 1 (2.50%) had coagulopathy and 1 (2.50%) had liver
disease. Furthermore, 3 (7.50%) patients were smokers. Among the 40 patients, 5 (12.50%)
had more than one comorbidity concomitantly.
Of the 40 patients who answered the questionnaire applied in the preoperative period,
only 25 (62.50%) answered the questionnaire referring to the postoperative period.
Sixteen (40.00%) patients were excluded. The exclusion of 15 (37.50%) patients was
due to non-response to the postoperative questionnaire. Also, 1 (2.50%) male patient
was excluded to maintain the standardization of the research, totaling 24 (60.00%)
patients.
The following figures represent each domain with its respective sub-items in graphs.
Furthermore, the p-value obtained by statistical analysis demonstrates whether or
not there was a significant improvement in the responses.
In Figure 1, referring to the domain satisfaction with the buttocks’ size/shape/firmness, an
improvement was observed in all response options, demonstrated by a p-value of less
than 0.05.
Figure 1 - Assessment of patient satisfaction with the buttocks’ size, shape, and firmness after
subcutaneous gluteal fat grafting.
Figure 1 - Assessment of patient satisfaction with the buttocks’ size, shape, and firmness after
subcutaneous gluteal fat grafting.
In Figure 2, referring to the gluteus appearance domain when fully dressed/in a bathing suit
or a bikini/undressed, the p-value for all questions was also less than 0.05, indicating
a significant improvement in the research result.
Figure 2 - Evaluate the appearance of the buttocks of the patient fully dressed, in a bathing
suit or bikini, and undressed after subcutaneous gluteal fat grafting.
Figure 2 - Evaluate the appearance of the buttocks of the patient fully dressed, in a bathing
suit or bikini, and undressed after subcutaneous gluteal fat grafting.
In Figure 3, referring to the domain satisfaction with the appearance of the buttocks, only the
question “For yourself” had a significant improvement in the answers (Table 1); in the other questions, the p-value was greater than 0.05, therefore, there is
no evidence to reject the null hypothesis, and the means of pre and post scores were
the same.
Figure 3 - Assessment of the satisfaction with the appearance of the buttocks for the patient
herself and people connected to her after subcutaneous gluteal fat grafting.
Figure 3 - Assessment of the satisfaction with the appearance of the buttocks for the patient
herself and people connected to her after subcutaneous gluteal fat grafting.
Table 1 - Satisfaction with the appearance of the buttocks.
| For yourself |
Pre (%) |
Post (%) |
p-value
|
| Very dissatisfied |
29.16 |
4.16 |
< 0.05 |
| A little dissatisfied |
54.16 |
8.33 |
| Neither satisfied nor dissatisfied |
4.16 |
8.33 |
| Reasonably satisfied |
12.5 |
29.16 |
| Very satisfied |
0 |
50 |
Table 1 - Satisfaction with the appearance of the buttocks.
In Figure 4, referring to the importance domain with the size of the buttocks, there was no significant
improvement in the responses in the sub-items “For yourself” and “For your husband/partner”
(Table 2), as the p-value was greater than 0.05. Thus, there is no evidence to reject the
null hypothesis, and the means of pre and post-scores were the same.
Figure 4 - Evaluation of the importance of the size of the buttocks for the patient and people
connected to her after subcutaneous gluteal fat grafting.
Figure 4 - Evaluation of the importance of the size of the buttocks for the patient and people
connected to her after subcutaneous gluteal fat grafting.
Table 2 - Importance of the size of the buttocks
| For yourself |
Pre (%) |
Post (%) |
p-value
|
| Very dissatisfied |
0 |
4.16 |
> 0.05 |
| A little dissatisfied |
16.66 |
4.16 |
| Neither satisfied nor dissatisfied |
8.33 |
4.16 |
| Reasonably satisfied |
25 |
16.66 |
| Very satisfied |
50 |
70.83 |
| For your husband or sexual partner |
Pre (%) |
Post (%) |
p-value
|
| Very dissatisfied |
4.16 |
4.16 |
> 0.05 |
| A little dissatisfied |
25 |
4.16 |
| Neither satisfied nor dissatisfied |
16.66 |
8.33 |
| Reasonably satisfied |
37.5 |
37.5 |
| Very satisfied |
16.66 |
45.83 |
Table 2 - Importance of the size of the buttocks
DISCUSSION
Plastic Surgery is a specialty where results are mainly evaluated by patient satisfaction11. Therefore, conducting studies to evaluate the quality of life and satisfaction with
the aesthetic results of patients submitted to subcutaneous gluteal fat grafting is
important.
Buttock augmentation, using implants or fat grafting, is among the fastest-growing
procedures performed in the United States, with a 90.3% increase over the five years
from 2015 to 201912.
Of the evaluated patients, the age ranged from 22 to 59 years. Compared to data from
the 2019 Census of the American Society of Plastic Surgery (The Aesthetic Society),
the prevalent age group of patients who underwent buttock augmentation using implants
or fat grafting was between 35 and 50 years of age12. Data were consistent with this study’s mean age (36.55 years).
The average BMI presented in the study was 27.38 Kg/m², which exceeds the data obtained
in the literature, whose average BMI is 24.9 Kg/m² in patients undergoing gluteoplasty
with autologous fat grafting13.
In this study, we were interested in evaluating the comorbidities presented by the
patients as possible interferences in the result. This was the reason why we added
it to the research patient profile. As there are no data in the literature for possible
comparisons, unfortunately, it was not possible to obtain results of the interference
of comorbidities in the results in terms of satisfaction.
In the present study, data analysis comparing the pre and postoperative responses
in the 8 domains assessed by the buttock assessment questionnaire shows a significant
difference (p<0.05) in most responses. However, it was noticed that in the domain of satisfaction
with the appearance of the buttocks, there was a significant improvement in the responses
only for the patient herself, in contrast to people connected to her. In the domain
of importance with the size of the buttocks, there was a significant improvement in
the answers for mother or father, sister(s), brother (s), and friend(s,) or the one
that the patient considers the most.
These findings are consistent with the study by Resende14, in which all satisfaction assessment questions and the total score improved significantly
in patients undergoing surgery, except for the question that assesses the importance
of breast size, in which there was no significant improvement in the patient’s responses.
However, it is important to point out that these studies differ regarding the body
region assessed.
Several studies demonstrate a high patient satisfaction rate after fat grafting events
and good aesthetic results subjectively assessed by photographs7,13,15,16. However, some of the studies are about fat grafting in the breasts, and no prospective
studies were found with instruments similar to those of this research that could serve
as a reference for assessing the quality of life and satisfaction of patients during
the preparation period.
Due to the limited sample size and the lack of studies with instruments that could
serve for possible comparisons, it would be interesting to replicate the essence of
the present study in future research to confirm the results.
CONCLUSION
With the results obtained, it is possible to conclude that subcutaneous gluteal fat
grafting improved the quality of life of the evaluated patients, showing a high level
of satisfaction in several aspects of their social life after performing this procedure.
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Buttock Assessment Questionnaire.
BUTTOCK ASSESSMENT QUESTIONNAIRE
To the patient: Write down the number most suitable for your answer. Use only one
alternative per answer. Please answer all questions. Do not leave any items blank.
1. How satisfied are you with each of the following items?
Please rate the questions by filling in the number according to the scale below:
1 = Very Dissatisfied
2 = A little dissatisfied
3 = Neither Satisfied Nor Dissatisfied
4 = Fairly Satisfied
5 = Very Satisfied
With the size of your glutes?
During intimate or sexual activities _____
During social or leisure activities _____
During professional activities or work _____
With the shape of your glutes?
During intimate or sexual activities _____
During social or leisure activities _____
During professional activities or work _____
With the firmness of your glutes?
During intimate or sexual activities _____
During social or leisure activities _____
During professional activities or work _____
2. How do you feel about the comfort or discomfort in each of the following items,
being alone, with your boyfriend or intimate partner, with other women in your relationship
(family or friends), with men in general, with less intimate women (gym or locker
room) or with health professionals (doctors or nurses)?
Please rate the questions by filling in the number according to the scale below:
1 = Very Uncomfortable
2 = A Little Uncomfortable
3 = Neither Comfortable Nor Uncomfortable
4 = Fairly Comfortable
5 = Very Comfortable
How about what your glutes look like when you’re fully dressed?
Alone _____
With your husband or partner _____
With men in general _____
With women in your relationship _____
With less intimate women _____
With healthcare professionals _____
How about what your buttocks look like when you’re in a bathing suit or bikini?
Alone _____
With your husband or partner _____
With men in general _____
With women in your relationship _____
With less intimate women _____
With healthcare professionals _____
As for what your buttocks look like when you’re undressed (unclothed)?
Alone _____
With your husband or partner _____
With men in general _____
With women in your relationship _____
With less intimate women _____
With healthcare professionals _____
3. Are you and those close to you satisfied with the (visual) appearance of your glutes?
Please rate the questions by filling in the number as per the scale below:
1 = Very Dissatisfied
2 = A little dissatisfied
3 = Neither Satisfied Nor Dissatisfied
4 = Fairly Satisfied
5 = Very Satisfied
To yourself _____
To your husband or sexual partner _____
Mother or Father (Whose opinion you value most) _____
Sister(s)/Brother(s) (Whose opinion you value most) _____
Friend(s) (Whose opinion you value most) _____
4. Do you and your people care about the size of your glutes (do you notice)?
Please rate the questions by filling in the number according to the scale below:
1 = Totally Unimportant
2 = Little Important
3 = Neither Important nor Unimportant
4 = Fairly Important
5 = Very Important
To yourself _____
To your husband or sexual partner _____
Mother or Father (Whose opinion you value most) _____
Sister(s)/Brother(s) (Whose opinion you value most) _____
Friend(s) (Whose opinion you value most) _____
1. Clínica Matioski, Curitiba, PR, Brazil
2. Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brazil
Corresponding author: Gabriel Paiva Kroneis Rua Jerônimo Durski 1533, Curitiba, PR, Brazil. Zip Code: 80730-290. E-mail: paivagabriel.gp@gmail.com
Article received: December 16, 2021.
Article accepted: September 13, 2022.
Conflicts of interest: none.
