Calf Implants

Overview

Calf implants are a popular cosmetic procedure aimed at enhancing the appearance and contour of the lower legs. People opt for calf implants for various reasons, such as improving their appearance, building muscle, addressing reconstructive needs, or as part of gender affirmation procedures. Typically performed by plastic surgeons, the primary goal of this procedure is to create a more sculpted and well–defined look for the calf muscles, providing them with a fuller and more muscular appearance. The surgical process involves carefully placing implants through small incisions made in the creases located at the back of the knees. 

The calf muscles play a vital role in the musculoskeletal system, contributing to essential functions like foot flexion and ankle rotation, enabling activities such as walking, running, and jumping. Prominently located in the posterior section of the lower legs, these muscles are situated behind the shinbones (tibias) and extend from the knees down to the Achilles tendons in the ankles. 

There are two primary muscles that comprise the calf muscles: 

• Gastrocnemius: This muscle is responsible for the bulk and shape of the calf muscles, giving them their distinctive appearance. 
• Soleus muscle: Situated deeper within the leg and characterized by its wide, flat shape, the soleus muscle plays a crucial role in calf muscle function, even though it remains hidden from view. 

Reasons for undergoing the procedure  

Calf implant surgery is an option for individuals of all genders looking to achieve more sculpted calf muscles. There are several compelling reasons to consider this procedure: 

• Correcting leg–related issues: Some people with leg injuries or congenital defects that result in muscle imbalances choose calf implants as a crucial component of reconstructive surgery to restore a more harmonious leg appearance. 
• Enhancing leg aesthetics: Many individuals opt for calf implants as part of their cosmetic surgery journey to improve the overall appearance of their legs. Bodybuilders, in particular, may seek calf implants to augment the size and definition of their lower legs, surpassing what exercise alone can achieve. Additionally, individuals with underdeveloped calf muscles, which may appear smaller or disproportionate to their thighs, can benefit from this procedure. 
• Achieving a masculine look: Assigned female at birth (AFAB) individuals who identify as male may opt for calf implants as part of their gender affirmation surgery. These implants help create a more muscular and masculine lower leg appearance, aligning with their gender identity. 

An ideal candidate for calf implants should actively participate in consistent exercise and strength training to promote calf muscle development, have a fully matured adult musculoskeletal system, refrain from smoking or be willing to quit before the procedure to reduce the risk of surgical complications and support proper healing, and maintain realistic expectations regarding the potential results achievable through calf implant surgery. 

Risks 

The risks of calf implant surgery include:  

• Infection.  
• Extrusion.  
• Muscle spasms.  
• Capsular contracture, which results in pain and an unusual hardness due to the scar tissue surrounding a silicone gel implant contracting and tightening.  
• The edge of the implant that you can feel through your skin (solid implants are more likely to have a palpable edge).  
• Adverse reaction to the implant or anesthesia.  
• Blood clots, bruises, and bleeding.  
• Skin sensitivity, discoloration, and edema.  
• Numbness and damage to nerves.

Procedure 

There are two methods for placing calf implants by your plastic surgeon: 

• Subcutaneous: In this approach, the calf implant is positioned just beneath the connective tissue between your skin and the gastrocnemius calf muscle. This method is often recommended for its minimally invasive nature, leading to a quicker recovery with reduced discomfort. However, subcutaneous implants are more susceptible to shifting, which might necessitate additional surgery for correction. Additionally, there is a possibility that the implant may be visible and palpable, potentially resulting in a less natural appearance. 
• Submuscular: With the submuscular technique, the calf implant is inserted beneath the gastrocnemius calf muscle, resulting in a slightly longer and more painful recovery period. Nevertheless, this approach provides a more secure and precise placement of the implant within the muscle, yielding a more natural look and feel. 

Before the procedure  

Preparing for calf implant surgery requires following your healthcare provider’s guidance. This preparation typically involves the following steps: 

• Medical evaluation: Prior to surgery, you will undergo a comprehensive physical examination and blood tests. This assessment is essential to ensure your overall health and readiness for the procedure. 
• Photographic documentation: Your healthcare provider will take photographs to aid in planning the surgery and to later compare your appearance before and after the procedure. 
• Fasting: You will be instructed to abstain from eating or drinking for a specific duration before the surgery. This fasting period is crucial to reduce the risk of complications during the procedure. 
• Medication management: Certain medications, including vitamins and supplements, may need to be discontinued prior to surgery. Your healthcare provider will provide specific instructions on which medications to stop and when to do so. 
• Antibiotic prophylaxis: To minimize the risk of postoperative infection, you will be prescribed antibiotics. It’s essential to take these antibiotics as directed by your healthcare provider. 
• Smoking cessation: If you are a smoker, it is strongly recommended that you quit smoking before the surgery. Smoking can hinder the healing process and increase the risk of complications. 

During the procedure  

Calf implant surgery typically involves the following steps: 

• Positioning: You will lie face down (prone) on the surgical table for the procedure. General anesthesia may be administered to keep you comfortably asleep throughout. 
• Incision: Your surgeon makes a small incision in the natural crease of skin behind your knee. 
• Creating a pocket: Using specialized surgical tools, the surgeon carefully creates a space (pocket) either between your connective tissue (skin) and the gastrocnemius calf muscles (subcutaneous implant) or within your actual calf muscle (submuscular implant). This step is performed with precision to avoid disturbing the nearby nerves, particularly the sciatic nerve branch responsible for motor and sensory functions in your lower leg and foot. 
• Implant placement: The calf implant is then inserted through the incision and positioned securely within the surgically created pocket. 
• Drainage tube (if necessary): In some cases, a thin drainage tube may be placed below the incision to temporarily remove fluids and reduce swelling. However, not everyone requires this. 
• Closure: The incision is closed with stitches, and a bandage is applied to cover the wound. 
• Compression bandage or garment: Your leg is wrapped in a compression bandage or garment to provide support and reduce postoperative swelling. 
• Repeat for the other calf: The same process is repeated on your other calf if you are getting implants on both sides. 
• Transition to recovery: Once the surgery is completed, you are gently rolled over to a face–up (supine) position to begin the recovery phase. 

After the procedure  

Following a medical procedure, it is important to have someone available to drive you home. You will be required to wear compression bandages on your legs to secure the implants and reduce swelling. Adhering to the surgeon’s instructions for incision care and proper drainage tube management is crucial. The stitches (if non–dissolvable) and drainage tube will typically be removed by the doctor within two weeks, at which point discontinuing the use of compression bandages is usually recommended.  

Outcome  

Following the procedure, expect several days of discomfort and pain, accompanied by swelling and tenderness in your lower legs as your skin stretches to accommodate the implant and the larger calf. Initially, walking may be uncomfortable and stiff, but it is crucial for promoting blood circulation and aiding in your recovery. Having assistance with movement during the first few days is recommended to prevent accidental falls, and typically, by the second or third week, your walking gait should return to normal. You should anticipate a return to work within two weeks and a gradual resumption of most regular activities within six weeks, although more strenuous exercises like running, biking, and strength training may require a bit longer to safely resume. 

To facilitate your recovery, consider the following: 

• Elevate your legs when lying down or sitting. 
• Use prescription or over–the–counter pain relievers containing acetaminophen. 
• Apply ice packs to your legs. 
• Continue taking any prescribed antibiotics. 

The results from calf implants will be immediately noticeable, but it may take several months for the swelling to completely subside, allowing you to fully appreciate the effects. 

In case you experience any of the following, make sure to contact your healthcare provider: 

• Severe pain. 
• Muscle spasms. 
• Nausea and vomiting. 
• Excessive bleeding, swelling, or bruising.
• Signs of infection, such as pus at the incision site or fever.