Distal Hand Migration of Polyacrylamide Gel after Breast Augmentation: A Case Report and Review of the Literature

Complications after breast augmentation with dermal fillers containing copolyamide: A systematic review

Background

Dermal fillers containing copolyamide are used for breast augmentation and are marketed under different labels, such as Aquafilling, Los Deline, Aqualift, and Activegel. In recent years, the number of publications reporting complications after use of these fillers has increased.

Methods

Through a computerized search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of published studies on complications, treatment options, and radiological findings related to breast augmentation with dermal fillers containing copolyamide was performed. Publications between January 1, 2007, and January 23, 2023, were included. Retrieved studies were screened for inclusion and quality assessment. The Joanna Briggs checklist for case reports and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies were used.

Results

Sixteen studies met the inclusion criteria: 14 case reports and 2 retrospective cohort studies, including 196 women and 333 complications. Long-term complications (≥30 days after surgery) were described in 15 studies. The most commonly reported complications were nodules in the breast (130 patients), pain (92 patients), inflammation and/or infection (43 patients), breast deformities (35 patients), and migration of the filler to the pectoralis muscle, abdominal wall, thoracic wall, pubic area, back, or upper extremity (27 patients). The median time between injection of the dermal filler and any complication was 18 months, and the majority of patients with complications required surgical intervention.

Conclusion

Given the reports of severe complications months to years after injection of dermal fillers containing copolyamide and the lack of studies evaluating long-term safety, our interpretation is that dermal fillers containing copolyamide should not be used for breast augmentation.

Granulomatous mastitis and pectoralis major muscle defect following polyacrylamide hydrogel injection: a case report and literature review

Background

Breast augmentation through the injection of polyacrylamide hydrogel (PAAG) was a popular procedure in the past, but it has since been prohibited due to various complications, including masses, migration, infection, inflammation, and even cancer. However, there were rare cases of granulomatous mastitis with pectoralis major muscle defect following PAAG injection for breast augmentation.

Case Description

A 40-year-old female patient presented with a swollen and suppurative mass in her left breast and was insensitive to antibiotics. She was admitted to our department for further treatment after 7 months with progressive local and general symptoms. Ultrasound imaging showed ill-defined heterogeneous echoes, and contrast-enhanced magnetic resonance imaging (MRI) revealed non-mass enhancement lesions in the multiregional distribution in Breast Imaging-Reporting and Data System 4A (BI-RADS 4A) with oedema in the retroglandular space and multiple enlarged lymph nodes in the ipsilateral axilla. Intraoperative observations revealed necrotic tissues, multiple abscesses, residual mucoid PAAG prosthesis diffused into the mammary glands and intramuscularly into the pectoralis muscle, and partial loss of pectoralis major muscle. Histopathological results revealed foreign-body granulomas accompanied by gel-like granular PAAG and proliferative inflammatory cells. She recovered after undergoing the characteristic surgical management in our center under general anesthesia and had no recurrence during the 2-year follow-up.

Conclusions

This case revealed that PAAG injection for augmentation mammaplasty, even after the removal operation, could result in subsequent complications, including granulomatous mastitis and pectoralis major muscle damage. PAAG filler complications are difficult to treat, therefore, it is essential to establish appropriate and effective therapeutic procedures.

Treatment of Complications After Minimally Invasive Breast Augmentation with Aquafilling Gel

INTRODUCTION

Recent studies have revealed that Aquafilling gel used for breast augmentation causes complications. In this study, we investigated which surgical approach should be used to treat these complications.

MATERIALS AND METHODS

This observational cohort study analysed the data of 31 women suffering from complications after breast enlargement with Aquafilling injection who were treated at our department in 2016-2021. Patients underwent either conservative or radical surgery. GraphPad Prism 9 (GraphPad Software, La Jolla, CA, USA) was used for data processing.

RESULTS

Approximately 88.89% of patients after conservative surgery required reoperation, while only 22.73% of patients treated radically needed revision surgery. Every patient who underwent an attempt to remove the gel via needle prior to admission required surgery. Seventy-five per cent of them had positive culture swabs, whereas only 26.09% of patients who did not undergo needle aspiration had positive cultures. A positive correlation between the volume of injected filler and the number of symptoms was observed.

CONCLUSIONS

In addition to irrigation and drainage, Aquafilling removal should include infiltrated tissue excision during primary surgery. Moreover, needle aspiration of the filler is ineffective, and it may lead to a gel infection. Furthermore, the more filler is injected, the higher the number of complications observed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .