Injection of Aquafilling(®) for Breast Augmentation Causes Inflammatory Responses Independent of Visible Symptoms

BACKGROUND: A major concern related to modern surgery is to evaluate and address the complications associated with breast enlargement using Aquafilling(®) injection. This study aimed to assess the effect of Aquafilling(®) injection on immune response in such patients. METHODS: For four patients who consulted a surgeon after receiving Aquafilling(®) injection, medical history of the patients was taken; based on imaging examinations, Aquafilling(®) was removed. Samples were processed for histopathological and immunohistochemical examination. For detecting tissue antigens in histopathological samples, monoclonal antibodies against CD3 (lymphocytes T), CD 20 (lymphocytes B), and CD68 (macrophages) were used. By analyzing the images, the number of immune cells (lymphocytes T, lymphocytes B, and macrophages) and immunohistochemical reaction area were semiquantitatively evaluated. RESULTS: Different clinical features were observed in each patient after receiving Aquafilling(®) injection. In samples obtained from four patients, lymphocytes T (CD3), lymphocytes B (CD20), and macrophages (CD68) tissue expressions were observed. Statistically significant variations in the number of lymphocytes B (CD20) and macrophages (CD68), and differentiation of immunohistochemical reaction area for lymphocytes T (CD3) and lymphocytes B (CD20) were observed. CONCLUSIONS: Inflammation is elevated in patients who received Aquafilling(®) injection. Medical imaging should be carried out in all such patients even if there are no visible symptoms. Removal of Aquafilling(®) can reduce the inflammation and risk of neoplastic progression in the patients. The influence of time elapsed since Aquafilling(®) injection and intensity of immune response requires further validation. 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.