Postoperative infections following silicone implant-based gluteal augmentation

Background Gluteal augmentation with silicone implants is increasingly performed worldwide, but postoperative infection remains one of the most relevant complications. This complication can significantly affect both the survival of the implants and the overall outcomes for patients. However, evidence regarding incidence, microbiology, risk factors, and management remains heterogeneous. Methods A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, the Cochrane Library and Latin American and Caribbean Literature in Health Sciences (LILACS) database were searched for studies reporting infectious complications following aesthetic gluteal augmentation with silicone implants. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach across the four prespecified outcome domains. Given clinical and methodological heterogeneity, data were synthesized narratively. Results Twenty-five studies, including 4937 patients, were included. Most studies were retrospective case series or case reports, with limited comparative evidence. Infection rates could not be reliably estimated because of heterogeneous definitions, incomplete reporting, and variable follow-up. Only a small number of studies provided microbiological findings, with Staphylococcus aureus being the most commonly identified bacteria in culture-confirmed infections. Available data were insufficient to determine the influence of implant plane, implant characteristics, or technical modifications on infection risk. Management strategies included antibiotic therapy and implant removal. According to JBI assessment, 15 studies were classified as low risk of bias, 6 as moderate risk, and 4 as high risk. The certainty of evidence was rated as low for infection incidence and very low for the remaining three outcome domains. Conclusions While postoperative infections in gluteal implant augmentation seem to be rare, they can lead to serious complications. However, the current evidence is limited due to methodological heterogeneity and inconsistent reporting. Prospective comparative studies using standardized definitions and detailed microbiological and clinical data are required to better guide prevention and management.