Repeated lumps and infections: A case report on breast augmentation complications

Abstract

BACKGROUNDPolyacrylamide hydrogel (PAAG) injections were once common in breast augmentation and have been prohibited for augmentation mammaplasty in China since a large number of patients who underwent breast augmentation with PAAG injections have continued to seek medical advice as a result of related complications. Among all these complications, distant migration is relatively rare.CASE SUMMARYA 49-year-old female presented at the hospital with a one-year history of a vulvar lump. The sonography of the lump showed several subcutaneous fluid-filled regions from the left vulva to the pubic symphysis, which suggested possible fat liquefaction. An enhanced magnetic resonance imaging (MRI) revealed a cystic area, which was considered a benign lesion. Intraoperative observations showed that the mass did not have an obvious capsule, the subcutaneous tissue presented as a cavity, and some yellow material came out of this cavity. A culture of the drainage did not show bacterial contamination. Histopathology revealed a foreign body granuloma. After resection and closed drainage, lumps were successively observed in the left lower abdomen and the bilateral hypochondriac region with infections. Sonography found that the hypoechoic areas in the bilateral hypochondriac region seemed continuous with deep in the breasts. The patient reported that she had undergone surgery with PAAG injections 20 years ago after she was repeatedly asked about her past history. Finally, a diagnosis of distant migration of PAAG was made.CONCLUSIONPAAG gel can migrate after long periods of time. A diagnosis should not be limited to the area where the symptom develops.

Remote migration of breast filler to the inguinal area: a case report

“…Complications include but are not limited to, indurations, infection, breast pain, contracture, and migration. Local migration is common, but migration to a distant location is relatively rare [3]. In this case report, we share a case of PAAG migration that was found outside the regional anatomy.…”

Granulomatous mastitis and pectoralis major muscle defect following polyacrylamide hydrogel injection: a case report and literature review

“…Certain factors, such as a tendency to gel migration, loose retromammary space, constant pectoralis major muscle contraction, and gravity, may allow PAAG to be carried through and rupture the connective breast tissues, chest wall, and abdominal wall along the retromammary space, causing local and general symptoms. Zhang et al ( 12 ) reported a case with a 1-year history of a vulvar lump filled with subcutaneous fluid-filled regions 20 years after PAAG augmentation mammaplasty. As a foreign body, PAAG can form a fibrous capsule within a pseudocapsule, and damage the structure of the pectoralis major muscle and extrapleural space ( 13 ).…”

Vulvar migration of injected polyacrylamide hydrogel following breast augmentation: a case report and literature review

“…There were only 4 cases of filler perineal area migration in total enrolled data according to our inclusion and exclusion criteria (Table 1 ) [ 4 , 6 , 8 , 9 ]. All the four patients were female; the age range was from 26 to 49 years old, with an average of 36.5.…”

“…The transit of PAAG from breast tissue to lymph nodes via lymphatic channels may also be an important factor in the metastatic process. Moreover, factors such as trauma, gravity and external pressure were believed to play essential parts in the migration of PAAG from the chest wall [ 4 , 8 ].…”

“…However, distant migration is relatively rare, especially from breast to the vulva. To date, only few cases have been reported in the literature [ 4 , 6 , 8 ]. These patients only underwent vulvar mass excision or chose nonoperative treatment because of fear of more aggressive surgical plan.…”