Complication after Aquafilling® gel-mediated augmentation mammoplasty—galactocele formation in a lactating woman: a case report and review of literature

Abstract

Augmentation mammoplasty using hydrogel fillers such as polyacrylamide gel (PAAG) or Aquafilling® has been performed commonly in some countries as an alternative to breast augmentation with saline or silicone implants. However, the safety of this procedure remains controversial, and many complications associated with the use of large-volume hydrogel injection have been reported in recent years. We present the case of a 33-year-old woman with a history of bilateral Aquafilling® injection augmentation mammoplasty who presented with an enlarged left breast while breastfeeding. Based on the clinical presentation and ultrasound findings, the patient underwent surgical incision as abscess formation caused by infection of the filler material could not be ruled out with certainty. Surgery revealed a galactocele with drainage of large amounts of milky fluid. Remaining filler material was removed as thoroughly as possible, and vacuum assisted wound dressing was performed. Galactocele formation in lactating women is a known complication after injection of hydrogel. Hence, it is important to be familiar with this uncommon but possibly severe complication in order to make an accurate diagnosis and initiate adequate treatment. To that end, it is recommended that patients who underwent Aquafilling® injection for breast augmentation should avoid lactation and that women intending to breastfeed should not undergo augmentation mammoplasty with injection of Aquafilling®.Level of Evidence: Level V, risk / prognostic study

Complications and management of breast augmentation using two different types of fillers: a case series

“…One patient (case 1) showed invasive ductal carcinoma, but the relationship with the filler injection is unclear. Common complications reported in other studies, such as migration, masses, and infection, were not found in our cases, and studies also vary in terms of the interval until symptom onset, which was 13.2 years in our study, but less than 10 years in others [3,5,7,8].…”

“…Although the use of fillers for body contouring, including breast augmentation, has not been approved by the Food and Drug Administration, fillers (e.g., hyaluronic acid, copolyamide, and polyacrylamide) have been and are still being used for breast augmentation [4,6,7]. The use of a PAAG filler (Amazingel) was approved by the Chinese Food and Drug Administration; however, it was banned in 2006 because of associated complications.…”

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

“…Fifteen of the 16 included studies reported complications, 6 , 7 , 9 , 10 , 11 , 12 , 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 and one study solely described a method of using Aquafilling to fill deformities after breast augmentation with implants. 8 …”

“…All in all, 196 women who had injections with dermal fillers containing copolyamide were included in this systematic review. The majority ( n = 191) had injections with Aquafilling/Los Deline, 6 , 7 , 8 , 10 , 11 , 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 and one study reported 5 women who had injections with Aqualift/Activegel 9 ( Table 1 ).…”

Management of a Large Quantity of Permanent Gluteal Copolyamide Fillers (Aqualift/Activegel): Literature Review and Algorithm

“… 8 , 9 AQUAlift/Aquafilling gel is not FDA approved. 10 There are numerous case reports 9 , 11-14 regarding complications related to Aquafilling breast augmentation. The most frequently reported complications include filler migration, late hematomas, skin fistulae, aspecific inflammatory symptoms, breast swelling, and deformity.…”