Management of Breast Deformity After Removal of Injectable Polyacrylamide Hydrogel: Retrospective Study of 200 Cases for 7Years.

Abstract

Polyacrylamide hydrogel (PAAG), once used as an injection for breast augmentation, has been banned in the medical field for cosmetic purposes for more than 10years in China. But a large number of breasts have characteristic deformities due to the gel's feature of erosion. Our aim is to explore a retrospective study on PAAG's long-term effects on women, ensuing breast deformity and the strategy for breast plasticity after removing the gel in our center from 2007 to 2014. From 2007 to 2014, 200 patients, whose breasts were injected with PAAG, underwent the operation to remove the injectable material. Complications were summarized. Ultrasound or MRI was performed before the operation to disclose the general distribution of the gel and the muscle and gland infiltration. According to the gel distribution, muscle and gland infiltration, infection, gel residue, and other factors, the patients were treated, respectively, with or without prosthesis implantation surgery after the removal of the gel. According to the decision about whether or when to undergo prosthesis implantation, the patients were classified into three types: group I-prosthesis implantation at the first stage, group II-prosthesis implantation at the second stage, and group III-only removing the material without prosthesis implantation. The scores of the BREAST-Q program were used to evaluate the preoperative and postoperative differences. Seventy-seven patients underwent prosthesis implantation at the first stage and 61 patients were operated on by placing the prosthesis at the second stage. A total of 62 patients only underwent the PAAG removal operation. By BREAST-Q evaluation, changes are summarized in Tables1, 2, and 3 between mean preoperative scores and mean postoperative scores through categories of satisfaction with appearance of breasts, psychosocial wellbeing, sexual wellbeing, and physical wellbeing, in which all categories were presented with statistical significance (p<0.001). Table1 Patient demographics General patient data Number Number of patients 200 Age range 25-48 Follow-up period 6-12months Injection material Domestic material 84 (42%) Imported material 93 (46.5%) Domestic+imported 23 (11.5%) Injection site Regular hospital 47 (23.5%) Clinics 153 (76.5%) Complication Inflammation 10 (2%) Pain 75 (37.5%) Induration 155 (77.5%) Shift 50 (25%) Deformation 17 (8.5%) Bilateral asymmetry 48 (24%) Deposition milk 2 (1%) Psychological fear 150 (75%) Systemic symptoms 34 (17%) Single complication 25 (16.97%) Two or more complications 160 (80%) Preoperative aspiration 48 (24%) Table2 Group I-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n=77) Postoperatively (n=77) p Satisfaction with appearance of breasts 18.8±16.2 81.6±13.1 <0.001 Psychosocial wellbeing 39.5±20.2 84.5±19.3 <0.001 Sexual wellbeing 38.7±23.1 77.2±20.5 <0.001 Physical wellbeing 42.4±16.3 81.7±10.5 <0.001 Table3 Group II-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n=61) Postoperatively (n=61) p Satisfaction with appearance of breasts 19.6±15.3 82.5±11.1 <0.001 Psychosocial wellbeing 38.9±19.3 83.6±20.1 <0.001 Sexual wellbeing 37.6±22.4 79.3±20.4 <0.001 Physical wellbeing 41.3±15.1 82.2±9.9 <0.001 CONCLUSIONS: Timely removal is critical for women who have received the PAAG removal operation. However, the surgery may destroy the shape of the breast. It is recommended that preoperative communication and local tissue condition are guidelines for surgeons to choose conservative or aggressive surgery. A balance must be maintained between removing the gel as much as possible and retaining soft tissue to reshape breasts. 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 .