BackgroundPolyacrylamide hydrogel (PAAG) injection has been used for breast augmentation, enjoying popularity for nearly 20 years in the late 20^th century. However, numerous complications were gradually observed in the years following the injection, including breast lumps, inflammation, firmness, and migration. Distant migration of breast fillers is relatively rare.Case DescriptionThis case report describes the treatment of a patient who experienced complications due to distant migration of fillers after PAAG injection for breast augmentation. The patient had a right-sided lumboabdominal mass measured approximately 35 cm × 20 cm, with asymmetrical breasts and a significantly smaller right-side breast compared to the left-side. The patient underwent surgery to extract the breast augmentation material from the lumboabdominal wall and breasts, followed by a robot-assisted excision of the lumboabdominal wall capsule and removal of residual breast augmentation agent in breasts, and immediate prosthetic breast reconstruction. Postoperative abdominal scarring was strategically concealed in an area that can be covered by pants, and the breast incisions were hidden under the axillary regions. The patient was satisfied with the abdominal scarring and reconstructed breasts.ConclusionsRobot-assisted excision of the lumboabdominal wall capsule is a feasible technique for extensive migration of breast fillers in the future. Further follow-up is needed to determine the long-term effects.

01 Sep 2024·Asian Journal of Surgery

Evaluation of safety, efficacy, and risk factors of different breast reconstruction strategies following polyacrylamide hydrogel removal: A 20-year retrospective cohort study of 436 cases

Article

Author: Liang, YeHua ; Chu, Xi ; Xu, Jinghong ; Yu, Yijia ; Sun, Qinqian ; Sun, Jiaqi

BACKGROUNDGlobally implemented for breast augmentation, polyacrylamide hydrogel (PAAG) always leads to breast deformity upon its removal. Despite a pressing need for breast reconstruction following PAAG removal to address aesthetic issues, the optimal timing remains controversial.METHODSA retrospective cohort study analyzed patients who underwent PAAG removal between 2003 and 2023. They were categorized into three cohorts: immediate (IBR), delayed (DBR), or no breast reconstruction (NBR) post-PAAG removal. Complication rates, re-operation frequencies, risk factors, and BREAST-Q scores were assessed.RESULTSA total of 436 breasts were identified and divided into IBR (n = 126), DBR (n = 48), and NBR (n = 262). Complication rates were 50.0 % (IBR), 31.3 % (DBR), and 26.7 % (NBR) (P < 0.001); reoperation rates were 26.2 % (IBR), 18.8 % (DBR), and 13.0 % (NBR) (P = 0.006). IBR showed significantly shorter complication-free survival than NBR (113.38 ± 8.34 vs. 178.21 ± 6.82 months; log-rank P < 0.001). Cox regression identified injection period, aspiration history, Baker grade II/III/IV, glandular infiltration, and IBR as independent predictors of higher postoperative complications. As for the Breast-Q scores, physical well-being was similar across groups. However, NBR scored significantly lower for postoperative sexual well-being (P < 0.001), psychosocial well-being (P < 0.001), and satisfaction with breasts (P = 0.001) compared to both IBR and DBR.CONCLUSIONSDBR is a safe and effective solution for secondary breast deformities after PAAG removal. Notably, patients with prolonged injection histories, previous aspiration history, Baker Grade II/III/IV, and MRI evidence of gel infiltration into glandular tissues are at a higher risk for postoperative complications. These findings may be beneficial for optimizing strategies to manage patients with PAAG injections in clinical practice.

01 Feb 2023·Journal of Plastic, Reconstructive & Aesthetic Surgery

Analysis of breast follow-up results in patients after polyacrylamide hydrogel (PAAG) or silicone prosthesis removal

Article

Author: Zou, Haiting ; Mo, Ran ; Yan, Xin ; Wang, Shuqin ; Lin, Yue ; Tan, Qian

BACKGROUNDPolyacrylamide hydrogel has been prohibited since 2006 due to numerous complications. Unsatisfactory breast contour was always observed in patients after PAAG removal. The same occurred in patients after silicone prosthesis removal. We attempt to compare and analyze the difference in postoperative breast conditions and pathology between the two groups.METHODSWe retrospectively reviewed the data of patients who underwent PAAG or silicone prosthesis removal between 2011 and 2021. The BREAST-Q was used to evaluate the follow-up results, including satisfaction with breasts, physical well-being, psychosocial well-being, sexual well-being, and the operation.RESULTSA total of 63 patients were analyzed. The PAAG group complained of more lumps or indurations (p = 0.004), benefited less from operations as for symptomatic relief (p = 0.002), and had more chronic inflammation(p = 0.000) than the silicone group. No breast cancer was found. All the Breast-Q scores were lower in the PAAG group than in the silicone group, and there was a significant difference in satisfaction with physical well-being (p = 0.035). Besides, patients without symptoms tended to score higher in all aspects of Breast-Q than patients with symptoms after removal. The two groups (symptom & no symptom) differed in psychosocial well-being (p = 0.043) and satisfaction with operation (p = 0.048).CONCLUSIONSThe breast contour of patients after PAAG or silicone prosthesis removal was worse than before. Early removal of PAAG before complications arise may result in a better surgical benefit. There is no doubt that PAAG are harmful both physically and psychologically. All patients are suggested to have PAAG injections removed.

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Indication	Highest Phase	Country/Location	Organization	Date
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