Late Hematoma, Seroma, and Galactocele in Breasts Injected With Polyacrylamide Gel

Abstract

Late hematoma or seroma and galactocele caused by augmentation mammaplasty have been reported in patients with silicon breast prostheses but are extremely rare in patients injected with polyacrylamide gel (PAAG). In a retrospective survey, the incidence, clinical manifestations, and management of late hematoma, seroma, and galactocele in 28 of 2,610 patients who underwent breast augmentation with PAAG injection were investigated, and 5 typical cases are presented. The diagnostic and managing methods for this complication have been assessed. The incidence of late hematoma or seroma was 0.65% and that of galactocele was 0.35% among patients with PAAG-injected breast augmentations. The clinical onsets of such late PAAG complications were of two types: rapid enlargement in 17 patients and progressive expansion in another 11 patients. Aspiration, ultrasound, and magnetic resonance imaging (MRI) are useful and sensitive tools for diagnosis. Foreign body reaction, PAAG-related tissue necrosis and fibrosis, and granuloma were shown, and the bacterial cultures in all 12 cases were negative. Needle aspiration with pressure dressing has been advocated as a reliable method for small diseases, and surgical exploration with irrigation-vacuum drainage and evacuation with capsulectomy have been considered more effective for recurrent, large, and long-term cases. In conclusion, these late complications rarely present after large-volume injections of PAAG for breast augmentation. The PAAG-related pathologic inflammatory tissue changes are suggested as the pathogenesis for the complication. Trauma and breastfeeding are considered to be stimulating factors.

A Case of Foreign-Body Granuloma of the Glabella due to Polyacrylamide Filler and an Intractable Ulcer after Skin Biopsy: An Immunohistochemical Evaluation of Inflammatory Changes

“…Among them, polyacrylamide hydrogel is widely used in cosmetic procedures as a filler material [2]. It is of note, however, that polyacrylamide hydrogel may not be safe or biocompatible [1, 2, 3, 4]. Here, we describe a patient who developed foreign-body granulomas on her glabella after an injection of polyacrylamide gel.…”

Recurrent complications of PAAG implants during lactation

“…Qiao et al 6 found that in a series of 30 patients (not all actively breastfeeding), nearly all had complications between 3 and 36 months post-operatively. Conversely, Cheng et al 10 found that the incidence of late seroma, galactocoele or haematoma was significantly rarer in patients with PAAG implants compared to silicone implants. Trauma and breastfeeding were contributing factors to developing complications 10…”

“…Silicone implants have complications similar to PAAG 10. However, due to a wider evidence base, it has been established that silicone confers no additional risks on the breastfeeding mother or baby, irrespective of whether the implants have ruptured 13…”

Polyacrylamide gel breast augmentation: report of two cases and review of the literature

“…In a study of patients undergoing surgery following PAAG augmentation, breast pain was the most common indication for surgery, followed by breast hardening and breast deformity [2]. Rarely, late complications such as hematomas, seromas, and galactoceles can result from PAAG breast augmentation [11]. Similar to PAAG, silicone granulomas may present as masses in breast tissue following extracapsular implant rupture or direct injection [12].…”

“…Saline irrigation and breast massage can facilitate the removal of all PAAG. In complicated cases where PAAG is too difficult to remove, local anesthesia can be used with ultrasound to better visualize PAAG distribution, especially in the posterior mammary space [11].…”