Men and women alike wish to have a more muscular and toned physique, and the calf region is not exempt from this. Despite vigorous exercise and body building, some people are unable to attain the definition that they desire in the calf. Many patients who present for consultation want to look good in shorts and skirts but due to a hypoplastic calf say that they are unable to do so. To that end, calf implants of various shapes and sizes have been created to increase volume in the calf.
HISTORY OF THE PROCEDURE
Over the course of the last 40 years since the introduction of calf augmentation for reconstructive purposes, there have been various surgeons that have proposed novel implant shapes and sizes along with varying locations for the placement of the implants. The implant most commonly used today is largely based on the silicone gel implants of Glitzenstein. However, Carlsen was the first to use calf implants back in 1972.2 His initial implant was made out of silastic foam. Glitzenstein, in 1979, used calf implants for patients with atrophy of the leg and muscular aplasia. Unlike Carlsen, his implants were designed from silicone gel.
Ultimately, it is at the surgeon’s discretion where to place the implant; however, based on anatomic studies it seems that the subfascial plane is a safe plane that allows for reproducible results with minimal risk of post operative complications and significantly less pain from the patient’s perspective. It is for this reason that the authors favor a sub-fascial plane in the medial aspect of the calf.
Calf Augmentation: A Single Institution Review of Over 200 Cases
Calf augmentation was originally designed to fill defects left following oncologic surgery, after trauma or infection, or due to genetic abnormalities. There are many causes for unilateral or bilateral calf deformities and they include but are not limited to the following: 1. Congenital hypoplasia due to agenesis of a calf muscle or adipose tissue reduction; 2. As a sequelae of clubfoot (talipes equinovarus), cerebral palsy, polio, and spina bifida; 3. Due to poliomyelitis or osteomyelitis; 4. Following fractures of the femur and as a result of burn contractures. While calf implants do not improve function of the affected extremity, patients are pleased with the improved aesthetic appearance of the leg after implantation.
Since its initial introduction, calf augmentation surgery has become a widely popular aesthetic procedure to help patients gain more shapely legs. Whether it is a body builder that is looking to “bulk up” the leg despite a vigorous exercise regimen or the average patient who wants a more shapely calf region, there are implants of various shapes and sizes to help add volume to a hypoplastic calf.
Some authors have noted that calf prostheses have the disadvantages of being unable to adequately correct ankle deformities, having a risk of displacement, having a risk of capsular contracture, and potentially having problems with extrusion. While we do agree that calf augmentation does not correct ankle deformities, we feel that this can be addressed with judicious fat grafting to the ankle region via small stab incisions at the medial and lateral malleoli.
THE CONSULTATION / IMPLANT SELECTION
Based on the patient’s existing anatomy and desires, the surgeon will find an implant suited to that patient.