Comprehensive management of breast augmentation with polyacrylamide hydrogel injection based on 15 years of experience: a report on 325 cases

BACKGROUND: As a permanent soft tissue filler, the use of polyacrylamide hydrogel (PAAG) has been banned due to its myriad complications. However, a large number of symptomatic and asymptomatic patients whose breasts were augmented with the gel injection have continued to seek medical advice. This study aimed to explore standardized clinical management of breast augmentation with PAAG. METHODS: The authors retrospectively collected the data of a total of 325 patients following PAAG injection for breast augmentation from 2003 to 2018. Magnetic resonance imaging (MRI) was performed preoperatively to disclose the general distribution of the gel and its infiltration into the muscle and gland. Debridement surgery, including the PAAG evacuation, pathologic tissue excision, and pocket irrigation via the periareolar incision, was performed. Immediate breast reconstruction (IBR) using silicone prostheses was carried out on 86 patients and delayed breast reconstruction (DBR) was performed on 35 patients. RESULTS: Most of the patients in the group were satisfied with their surgical outcome, their symptoms disappeared after the debridement surgery, and they experienced no relapse or recurrence. Unfortunately, for most of the cases, it was extremely difficult to remove the PAAG completely—however, improved quality of life as seen through the BREAST-Q evaluation. CONCLUSIONS: With the guidance of MRI images, surgery, including PAAG evacuation, pathologic tissue excision, and pocket irrigation via the periareolar incision, was a reliable method to ensure the maximal removal of the PAAG. Immediate or secondary breast reconstruction with sub-glandular placement of silicone prostheses showed a satisfactory mid-term effect.