Surgical Management after Breast Augmentation with Polyacrylamide Gel

Background

Polyacrylamide gel(PAAG), also known as Aquafilling^® has been approved and is now commercially available in South Korea. Patients are not aware of the complications of the product when it is injected to the soft tissue, and have suffered after having the product injected to their breast which is an off-label usage. Typical symptoms include breast asymmetry, localized lumps, pain, and gel migration to the breast bottom. Additionally, while detecting breast cancer, the product could interfere the examiner by blocking the cancer cells. It is also known as a cause of breast cancer if the polymer breaks into the monomer.¹ Although there are adverse complications, Polyacrylamide is still currently widely used in Korea.

Methods

During 2017 and 2018, 9 patients between the ages of 22 to 50 years old underwent surgical management of the problems after breast augmentation with Aquafilling®. The patients’ history was retrieved regarding the injection site, the duration between the injection period and symptom arousal was estimated. The injected plane and amount were evaluated with sonography (Samsung Medison, Korea) examination before and after the surgery. The gel that washed out, was sent to a lab (Andong National University, South Korea) to check the particles with a digital microscope (MXG--2500REZ, Hirox, USA).

Results

Palpable lump was the main complaint of the patients. Three patients experienced tenderness during menstruation period with redness and heat sense. One patient, who had the removal from another clinic through the periareolar approach, still had the gel inside their body. This was managed by another surgery through the axillary approach. The healing of the incision is interfered by the gel migrating due to the gravity, thus the inframmary or periareolar incision was avoided. 2 patients had injections in multiple layers and was impossible to completely remove the gel, especially in the glandular tissue. The patients were informed to examine their glandular tissue regularly. After the removal of the gel, all 9 patients had immediate insertion of the silicone implants at the same plane. All patients were satisfied with the shape of their breast and achieved improvements in symptoms. However, all 9 patients experienced psychological stress, depression with the gel and to their previous doctor. The patient who had periareolar incision at the other clinic also had disruption at the wound and was revised.

Conclusions

Based on the author’s experience, polyacrylamide hydrogel injections should be restricted for breast augmentation. Doctors who are not aware of the danger of this substance are using it to augment soft tissue including the breast size. Caution should be taken to those who might consider using PAAG as a means of augmentation mammoplasty. Furthermore, patients who have had the injection but do not yet have any symptoms, should undertake regular examination for gel migration or any other forms of complication.  

Reference

 

1. Nak, K.S., and Park, E.S. Letter: Correcting Shape and Size Using Temporary Filler after Breast Augmentation with Silicone Implants. Archives of Aesthetic Plastic Surgery. 22(1), 2016