Removal Of Polyacrylamide Hydrogel Research Articles

Analysis of breast follow-up results in patients after polyacrylamide hydrogel (PAAG) or silicone prosthesis removal

BackgroundPolyacrylamide hydrogel has been prohibited since 2006 due to numerous complications. Unsatisfactory breast contour was always observed in patients after PAAG removal. The same occurred in patients after silicone prosthesis removal. We attempt to compare and analyze the difference in postoperative breast conditions and pathology between the two groups. MethodsWe retrospectively reviewed the data of patients who underwent PAAG or silicone prosthesis removal between 2011 and 2021. The BREAST-Q was used to evaluate the follow-up results, including satisfaction with breasts, physical well-being, psychosocial well-being, sexual well-being, and the operation. ResultsA total of 63 patients were analyzed. The PAAG group complained of more lumps or indurations (p = 0.004), benefited less from operations as for symptomatic relief (p = 0.002), and had more chronic inflammation(p = 0.000) than the silicone group. No breast cancer was found. All the Breast-Q scores were lower in the PAAG group than in the silicone group, and there was a significant difference in satisfaction with physical well-being (p = 0.035). Besides, patients without symptoms tended to score higher in all aspects of Breast-Q than patients with symptoms after removal. The two groups (symptom & no symptom) differed in psychosocial well-being (p = 0.043) and satisfaction with operation (p = 0.048). ConclusionsThe breast contour of patients after PAAG or silicone prosthesis removal was worse than before. Early removal of PAAG before complications arise may result in a better surgical benefit. There is no doubt that PAAG are harmful both physically and psychologically. All patients are suggested to have PAAG injections removed.

Immediate prosthetic breast reconstruction after removal of the polyacrylamide hydrogel (PAAG) through a small areolar incision assisted with an endoscope

BackgroundTo identify the feasibility, safety, cosmetic outcomes and patient satisfaction of immediate prosthetic breast reconstruction after removal of Polyacrylamide Hydrogel (PAAG) through a small areolar incision assisted with an endoscope.MethodsThis was a retrospective study. Medical records of 87 patients who underwent PAAG removal were reviewed retrospectively from February 2010 to December 2019. These patients were dichotomized based on whether they accepted immediate prosthetic breast reconstruction after PAAG removal or not. A comprehensive analysis on the data was conducted to observe the surgical results, cosmetic outcomes, health-related quality of life (HRQOL) and patient satisfaction.ResultsSixty-two patients underwent PAAG removal through a small areolar incision assisted with an endoscope, while another 25 patients underwent further immediate prosthetic breast reconstruction after PAAG removal. All the patients recovered smoothly after operation. In the immediate breast reconstructed group, most of the breasts were natural in appearance, but one patient had mild nipple and breast asymmetry, and another had mild breast asymmetry. Three patients had PAAG residual, and one of them accepted fine needle aspiration. The cosmetic satisfaction rate was 88% and 92% by surgeons and patients, respectively. In the other group, seven patients suffered from PAAG residual, one patient suffered from postoperative bleeding, and five patients suffered from skin laxity. The BREAST-Q scores revealed that patients who accepted immediate breast reconstruction had significant better outcomes in psychosocial well-being (p = 0.030), satisfaction with breasts (p = 0.021), when compared to patients who only accepted PAAG removal, while similar in sexual well-being (p = 0.081), physical well-being chest (p = 0.124), and satisfaction with outcomes (p = 0.068), and satisfaction with care (p = 0.077).ConclusionImmediate prosthetic breast reconstruction after PAAG removal through a small areolar incision aided with an endoscope might be a viable and safe technique, with better psychosocial well-being and satisfaction with breasts.

Management of Complications in 257 Cases of Breast Augmentation with Polyacrylamide Hydrogel, using Two Different Strategies: A Retrospective Study.

Polyacrylamide hydrogel (PAAG) has been used globally for breast augmentation, leading to long-term clinical complications. However, whether the infiltrated fibrotic capsule should be removed with PAAG to alleviate the complications remains unclear. This study aimed to ascertain different causes of complications and proper management strategies for PAAG removal in augmented breasts. From July 2015 to December 2019, patients who underwent breast augmentation with PAAG and in whom surgical intervention was undertaken for PAAG-associated adverse events at Shanghai Ninth People's Hospital were retrospectively reviewed. Patients were categorized into two groups according to whether the fibrotic capsule was removed (RFC) or not (NRFC). Aesthetic outcomes, PAAG residues, and adverse events were evaluated post-operatively to assess whether important issues pertaining to these arose following fibrotic capsule removal. Tissue histology and PAAG degradation analysis were implemented to investigate immune response, degradability, and toxicity of PAAG. Altogether, 257 patients (88 RFC and 169 NRFC patients) were enrolled. 73.4% and 79.5% of the RFC and NRFC groups showed fairly good outcomes, with no significant difference, respectively. (X2 = 0.0804, p = 0.79) Significant differences were found between two surgical techniques upon patient satisfaction, respectively. (X2 = 3.529; p = 0.0301). Predictor of poor outcomes identified scar (OR, 4.555, p = 0.0019) and PAAG residue (OR, 5.379, p = 0.0003). Predictor of patient satisfaction identified post-operative outcomes (OR, 3.797; 95% CI, 1.860-8.923; p = 0.0002) and surgical technique (NRFC) (OR, 2.519; 95% CI, 1.449-4.434; p = 0.0008). Both treatment strategies showed good results in our study. Removal of the fibrotic capsule from infiltration of PAAG largely depends on the individual psychological condition, aesthetic expectations, complications, and magnetic resonance imaging results. While PAAG does not degrade in the host's body over time, it may elicit immune reactions and chronic inflammation in the long term. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Breast Augmentation with Autologous Fat Grafting Immediately after Removal of Polyacrylamide Hydrogel and Fibrotic Capsule in 162 Patients

Objective: In this study, we investigated the feasibility and efficacy of immediate breast augmentation with autologous fat grafting after removal of polyacrylamide hydrogel (PAAG) and fibrotic capsule. Methods: A retrospective study was conducted on 162 female patients who underwent removal of breast filler PAAG and the fibrotic capsule which produced after injection of PAAG via areola omega-shaped incision. Then autologous fat grafting was immediately performed evenly and radially around the areola via the same incision into different layers (subcutaneous, submammary tissue, pectoralis major intramuscular, and inferior pectoralis major space) except the empty cavity. The cavity left by removal of PAAG and fibrous capsule was closed with negative pressure drainage tube and slight external pressure. Results: All patients recovered well without severe complications. The average score of postoperative satisfaction with physical well-being: chest was 99.83 (total score: 100) compared with the average satisfaction score of 71.69 (total score: 100) preoperatively by means of BREAST-Q™ evaluation (p < 0.01). All patients were satisfied with their postoperative breast shape. Conclusions: Removing as much as possible is critical for patients who underwent the PAAG injection. Our experience in immediate breast augmentation with autologous fat grafting after removal of PAAG and fibrotic capsule proved useful and effective to maintain the balance between removing the PAAG as much as possible and retaining soft tissue to reshape breasts. Level of Evidence: IV.

Autoimmune syndrome induced by adjuvants after breast enhancement with polyacrylamide hydrogel: a study in Poland

Autoimmune syndrome induced by adjuvants (ASIA) is the spectrum of diseases in which the substances considered inert to the body induce autoimmune reactions and inflammation. Some of the biomaterials recently used in plastic surgery, such as silicone or polyacrylamide hydrogel (PAAG) seem to trigger clinical features of ASIA. The aim of this study was to assess the incidence of these features within a group of women after breast augmentation with PAAG. As many as 30 consecutive patients (26–59 years, mean age 39.5) referred to the Clinic of Plastic Surgery after breast enhancement with PAAG were examined. The validated criteria of ASIA syndrome were employed. Descriptive statistics were chosen based on the distribution of variables. The research was approved by the Bioethical Committee of the Centre of Postgraduate Medical Education in Warsaw, Poland. Within the studied group, 50% of patients (n = 15) fulfilled ASIA diagnostic criteria. Apart from local complications, we encountered various general symptoms, among which fever (n = 13, 43.3%), tingling and numbness of upper extremities (n = 10, 33.3%) and chronic fatigue (n = 9, 30%) were the most common. These symptoms were present on an ambulatory visit, before qualification to the operation of hydrogel removal. All patients undergoing surgical PAAG removal (n = 8) declared alleviation or complete resolution of the symptoms. Polyacrylamide hydrogel breast filling, although limiting the invasiveness of the procedure in relation to silicone breast implants, also carries the risk of developing ASIA symptoms. The removal of PAAG may bring improvement in some cases.

Different Types of Breast Deformity Induced by Two Types of Polyacrylamide Hydrogel and Corresponding Treatment.

Polyacrylamide hydrogel (PAAG) was once used as an important injection for breast augmentation though it has been banned in China for more than 10years. Secondary breast deformity after removing PAAG poses a challenging problem. The aim of this article is to introduce types of breast deformity induced by two types of PAAG based on MRI examination and corresponding treatment strategies. From 2008 to 2017, 300 patients with the history of injectable PAAG were reviewed. From their medical history, two types of PAAG injections were imported Interfall and domestic Amazingel, 182 patients received Interfall injection and 118 patients received Amazingel injection. MRI was used as a regular examination preoperatively. According to MRI examinations, breast deformities were classified into nodular type, flow type and mixed type. All of them underwent PAAG removal operations. In the 182 patients with Interfall injection: There were only 5 cases of nodular type, 3 cases received immediate breast augmentation and 2 cases received second-stage breast augmentation, and none of cases received breast augmentation; there were 170 cases of flow type, 165 cases received immediate breast augmentation and 5 cases received second-stage breast augmentation, and none of cases received breast augmentation; there were 7 cases of mixed type, 5 cases received immediate breast augmentation, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation; in the 118 patients with Amazingel injection: There were 111 cases of nodular type, 20 cases received immediate breast augmentation, 51 cases received second-stage breast augmentation and 40 cases did not receive breast augmentation; there were 4 cases of flow type, 2 cases received immediate breast augmentation, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation; there were 2 cases of mixed type, 1 case received second-stage breast augmentation and 1 case did not receive breast augmentation, and none of cases received immediate breast augmentation . Breast deformity induced by two types of PAAG can be classified into three types based on MRI examinations, which is very critical for preoperative evaluation and classification. Each type of deformity has its own characteristics, which serves as a guide for whether a first-stage or a second-stage prosthesis implant can be implemented. The proportion of patients who can have breast augmentation in the first or second phase after injection of Interfall is significantly higher than that of patients who have injections of Amazingel. 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.

Application of Periareolar Mammaplasty with the Tissue Folding Technique in Breast Reshaping following Polyacrylamide Hydrogel Removal

Background: Polyacrylamide hydrogel (PAAG) was used as an injectable implant for augmentation mammoplasty for over 30 years, but its use was ceased due to various related complications. The only way to treat these complications is PAAG removal, but this causes breast ptosis, nipple retraction, breast asymmetry, and skin laxity. Objectives: This article reports a new technique for breast reshaping after PAAG removal without prosthesis implantation. Method: From January 2015 to June 2018, twenty-three patients underwent periareolar mammoplasty with the tissue folding technique (PMTFT) for breast reshaping after PAAG removal. Postoperative breast shape and the degree of satisfaction of the patients were evaluated during follow-up. Results: All patients recovered well without severe complications. All patients were satisfied with their postoperative breast shape and their symptoms were relieved after surgery. Conclusions: PMTFT provides satisfactory postoperative breast shape results. Economical, practical, and technical advantages were found over traditional prosthesis-mediated breast reconstruction. PMTFT can be an ideal surgical choice in appropriate cases.

Removal of Polyacrylamide Hydrogel Injected in Different Layers for Breast Augmentation

Background: The complications of polyacrylamide hydrogel (PAAG) injected for breast augmentation have captured the attention of the physicians and patients. More and more patients are seeking for the removal of it. In this article, we analyzed the effectiveness of the removal of PAAG injected for breast augmentation by using an inferior periareolar incision under the direct visualization. We got to know the extents of the removal of PAAG injected in different layers. Methods: Fifty patients (99 breasts) for the removal of PAAG were randomly selected. On the basis of the preoperative and postoperative MRI, the patients were divided into four groups according to whether the PAAG infiltrated to the subcutaneous tissue and muscles or not. In each group, the volumes of PAAG before and after the removal were calculated to analyze the removal amount of the PAAG injected in different layers. Results: The mean volume of injected PAAG was 264.81 ml. The mean volume of residual PAAG was 9.18 ml. The mean percentage of the removed PAAG was 96.49%. There was no significantly difference in preoperative volume of injected PAAG among different groups p=0.992). There was significantly difference in postoperative volumes of residual PAAG after removal among different groups (p=0.000). Conclusions: The PAAG injected for breast augmentation and degenerated tissue could be removed using the direct visualization method to obtain successful removal of the great amount of PAAG. The PAAG without infiltrated to the subcutaneous tissue and muscles was most easily removed. The infiltration of the subcutaneous tissue and muscles increased the difficulty of the removal the PAAG.

Clinical observation of the effect of breast removal of polyacrylamide hydrogel by areola medial semicircular incision

Objective To learn the effect of breast removal of polyacrylamide hydrogel by areola incision; and to provide an effective method for removal of polyacrylamide hydrogel. Methods According to the accepted operation, 45 cases with breast polyacrylamide hydrogel were divided into 25 cases of observation group and 20 cases of control group.The observation group was treated with areola medial semicircular incision breast removal of polyacrylamide hydrogel, and the control group was treated with areola small incision suction to remove polyacrylamide hydrogel.The operative time, intraoperative blood loss, postoperative drainage tube extraction time, postoperative 7d breast shape and perioperative complications of the two groups were observed; postoperative follow-up was performed to evaluate the effect of surgery. Results The operation time of the observation group (190.2±36.1)min was longer than (119.5±44.0)min of the control group, the difference was statistically significant between the two groups (t=5.924, P 0.05); the postoperative drainage tube extraction time of the observation group (3.7±0.5)d was more than (2.3±0.3)d of the control group, the difference was statistically significant (t=11.021, P 0.05). All cases of the two groups were followed up; the mean follow-up time was (6.7±2.1)months.The good rate of surgery of the observation group was 92.0 % (23/25), which of the control group was 70.0%(14/20), the observation group was higher than the control group (χ2=5.718, P<0.05). Conclusion For patients with complications after polyacrylamide hydrogel injection for augmentation mammoplasty; the breast polyacrylamide hydrogel removal surgery by areola medial semicircular incision is recommended as the preferred. Key words: Polypropylene; Breast implants; Device reval; Surgical procedures, Minimally invasiue

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

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 .

Application of acellular allograft dermal matrix in breast implants for secondary breast deformity post polyacrylamide hydrogel removal

To evaluate the safety and efficiency of acellular dermal matrix combined with implant in correcting the secondary deformity post polyacrylamide hydrogel removal. A retrospective study enrolling 23 female patients (42 breasts) who received breast deformity correction from June 2008 to June 2012 with acellular dermal matrix and implant were performed. One patient suffered bilateral seroma and 1 patient suffered infection in one side. None of the implants were removed. Patients were followed up for (15.0±11.7) months (range: 3-36 months), and the results were satisfactory. Acelluar dermal matrix and implant can be safely used simultaneously in correcting the secondary breast deformity post polyacrylamide hydrogel removal.

Instant implantation of breast after removal of polyacrylamide hydrogel for breast augmentation

Objective To investigate the clinical indication and effect of instant reconstruction of breast after removal of polyacrylamide hydrogel injection for breast augmentation.Methods Patients had breast ultrasound,MRI check before operation,to define the distribution and level of the injections and tissue infiltration.Depending on tissue degree,capsule integrity and breast degeneration situation,three different methods were chosen,including implantation of silicone gel underneath the breast,pectoralis major or dual-plane.Results 56 patients' incision healed well.Follow-up for 6 months to 3 years showed that breast shapes were good without scars,prosthetic herniapsular,capsular contracture and other complications.Conclusions Instant reconstruction of the breast after removal of polyacrylamide hydrogel injection can improve breast shape and get satisfied effects. Key words: Polyacrylamide hydrogel; Silica gel; Breast implants; Breast augmentation surgery

Treatment of postoperative complications after augmentation mammoplasty by polyacrylamide hydrogel injection

Objective To explore the complications of augmentation mammoplasty by polyacrylamide hydrogel (PAHG) injection and their management.Methods Preoperatively,174 patients underwent breast ultrasound image,and some patients received magnetic resonance imaging (MRI) to ascertain the distribution of injected PAHG.We used the periareolar incision and dissection extended to the subcutaneous tissue,mammary gland,and subgland space.We were able to suck most of the gel by the negative pressure machine and remove the abnormal breast tissue.The secondary breast deformity was repaired with subpectoral placement of silicone mammary implants (48 cases immediately,39 cases secondarily after 3-6 months) according to the individual situation.Results Following-up for 3 to 6 months,most of their symptoms were relieved after removal of the polyacrylamide hydrogel.In the patients who were performed with the implants augmentation mammoplasty,77 cases gained satisfactory results on the shape and texture of the breast (44.3％),and 10 cases were not satisfied with texture of the breast (5.7％).79 cases appeared breast atrophy or flat chest (45.4％).The severe breast deformities occurred in 8 cases (4.6％).Conclusions PAHG should be removed with surgical operation as soon as possible.The open operative technique via periareolar incisions may be a better method for the patients.The breast reconstruction is performed with implants prosthesis for those who are suitable and willing after removal of PAHG. Key words: Polyacrylamide hydrogel; Augmentation mammoplasty; Complication

Successful removal of polyacrylamide hydrogel by pulsed fiberoptic 1444-nm Nd-YAG laser

Background: Tissue augmentation by polyacrylamide gel (PAAG) may lead to displacement or complications several years later and necessitate its removal. Objective: To use a fiberoptic 1444-nm neodymium-doped yttrium aluminum garnet (Nd-YAG) laser for removing polyacrylamide hydrogel augmentations. Methods: Five patients with frontal and cheek augmentations were referred for gel removal. After nerve block anesthesia, a 600-μm optical fiber tip with a metallic cannula was inserted into a hole created by a 16-gauge needle, and the laser was triggered. The cannula was moved in a fan pattern in the augmented area and was then removed. The tissue was squeezed from its outermost region toward the hole to extrude the gel. The laser system used was a 1444-nm fiberoptic Nd-YAG, obtained from Lutronic lasers, South Korea. The parameters used were: pulse rate = 30, pulse energy = 150 J, power = 4.5 W, and total energy = 400–1200 J. Results: The heat of the laser tip liquefies the gel and by coagulating the surrounding tissues, it produces multiple patent canals. These two factors facilitate gel removal by squeezing the tissues. No temporary or permanent complication, such as hematoma, burning, or fibrosis, was detected. Conclusion: The 1444-nm Nd-YAG laser is a safe and efficient method for removing subcutaneous polyacrylamide hydrogel.

Long-term Complications from Breast Augmentation by Injected Polyacrylamide Hydrogel

Long-term Complications from Breast Augmentation by Injected Polyacrylamide Hydrogel

Effect of TCM psychological intervention on stress response of patients with breast augmentation operation once again after the removal of polyacrylamide hydrogel

Objective To study the effect of TCM psychological intervention on stress response of patients with breast augmentation operation once again after the removal of polyacrylamide hydrogel.Methods A total of 68 patients were randomly divided into two groups.The patients in control group were treated with routine nursing,and the patients in research group were treated with additional attached ear acupressure TCM psychological intervention.Variables including patients′anxiety,pain,heart rate,systolic and diastolic pressure,ACTH,Cor,IL-6 were monitored and compared on the second day of admission to hospital,first day post -op and the first day of release from hospital between two groups.Results All variables of experimental group were better than those of control group with statistical significance.Conclusions Attached ear acupressure along with TCM psychological intervention can alleviate patients′anxiety,stabilize blood pressure and heart rate and reduce post-op pain and discomfort. Key words: Breast augmentation once again; TCM psychological intervention; Ear acupoint

Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients

Polyacrylamide hydrogel (PAAG) was once widely used in breast augmentation in China. Although it had been banned for augmentation mammaplasty in 2006, a large number of patients whose breasts were augmented with the gel injection have continued to seek medical advice because of its complications. The clinical management of these complications has never been standardised. The data of a total of 235 patients with complications following PAAG-injected breast augmentation have been summarised and the types and causations analysed. Magnetic resonance imaging (MRI) was undertaken in 228 patients with palpable masses, breast pain or tenderness, asymmetry or deformity and functional or psychological problems to eliminate neoplasm, infection and to delineate the diseases. The surgical gel evacuation via periareolar incisions was performed for all patients and immediate silicone breast prostheses were implanted in 108 patients and were delayed in 28 cases by 6 months. Most patients (214/235) of the group were satisfied with the treatment, and symptoms disappeared after removal of the gel. The gel distribution and involved tissue were well defined and neoplasm was ruled out by MRI. Postoperative MRI in 68 patients revealed that no obvious PAAG remaining. In either immediate or delayed reconstructive patients with silicone breast implants, good breast contour presented. A diagnosis and management strategy for these complications is proposed. In conclusion, the breast masses, pain and deformity are major complications after PAAG-injected breast augmentation. Psychological problems should be paid attention to. MRI is a sensitive and accurate method for diagnosis and treatment evaluation. Surgical removal of injected gel is the preferred method for complication management. The implantation of silicone prostheses for breast contour restoration after PAAG evacuation is effective for patients under strict selection. Our strategy for treating PAAG-related complications proved useful.

Removal of the Permanent Filler Polyacrylamide Hydrogel (Aquamid) Is Possible and Easy Even after Several Years

Sir: In fillers for soft-tissue augmentation, not only safety and efficacy but also possible removal is of concern. The necessity for extensive surgery to remove some fillers deters many surgeons from their use.1 We report on the easy removal of polyacrylamide hydrogel, marketed as Aquamid. Several long-term studies proving its safety and efficacy have been published.2 Few reports are found about complications, yet some cases required removal.3 Experience with removal of the gel has not yet been described. Aquamid is considered to be inert, but gel accumulations, especially on the lip, occur sporadically. This complication can be seen shortly after injection, but also after several years. The following two cases represent examples of the surgical removal of Aquamid. Patient 1 was a 42-year-old woman who presented with asymmetry on the upper lip following previous trauma and scarring. She underwent treatment with 2 ml of Aquamid. After 3 months, she presented with overcorrection and several small lumps in the upper lip. Because of the scarred tissue, the application had been too superficial and manual modulation after application was insufficient. Removal of the excess gel was possible by direct excision using local anesthesia. Patient 2 is a 34-year-old woman who sought consultation for lack of projection of the upper lip. She received 4 ml of Aquamid to the upper and lower lips and was satisfied with the result. After 6 years, she developed asymmetry and bulging in the upper lip. This was possibly related to a rhinoplasty procedure performed several months before. In this patient, easy and complete removal of the lump could be achieved by needle aspiration (Fig. 1) and manual expression through a small stab incision using local anesthesia (Fig. 2).Fig. 1.: Patient 2, undergoing needle aspiration to remove excess gel.Fig. 2.: Patient 2, undergoing manual expression through a stab incision.In conclusion, we find that removal of Aquamid is possible but should be performed under surgical precautions. In case of erroneously superficial application, the material can be excised directly; otherwise, manual expression and/or needle aspiration is possible. Visible scars can almost always be avoided. Most undesired results with fillers can be attributed to incorrect application4; nevertheless, even if all precautions are taken, removal may be desired. An altered body image or changes in facial architecture with aging or caused by additional surgery or subcutaneous tissue dystrophy associated with weight changes can necessitate filler removal even after several years. Easy removal is safest when there is no tissue ingrowth and no significant capsule formation that needs to be removed surgically. Permanent fillers are either hydrophilic, hydrophobic, or combination products. Hydrophilic fillers, such as Aquamid, seem to induce the least capsule formation and tissue ingrowth, probably because the water exchange allows reduction of a biofilm.5 Because necessity of removal cannot be ruled out for any permanent filler, polyacrylamide hydrogel seems to be a good option, as it has been in successful clinical use for more than 16 years and allows for correction even after a long time. Timm P. Wolter, M.D. Norbert Pallua, M.D., Ph.D. Department of Plastic and Reconstructive Surgery, Hand Surgery, Burn Center University Hospital of the RWTH Aachen, Germany DISCLOSURE The authors have no financial interest in any of the products mentioned in this article.

Analysis and treatment of the complications caused by polyacrylamide hydrogel injection for augmentation rhinoplasty

Objective To analyze the causes and explore suitable treatments for the complica-tions induced by polyacrylamide hydrogel (PAHG) injection for augmentation rhinoplasty. Methods The causes of the complications of 52 cases who accepted PAHG injection for augmentation rhinoplas-ty were analyzed and summarized. All the patients were treated by surgical operations to remove the injected PAHG. Results The complications included infection, granuloma, skin ulceration, bad shape, pain and serious psychological stress. Each case had 1 to 4 complications. Satisfactory results were obtained after suitable treatments. Some cases had silicone or expanded polytetrafluoroethylene implant augmentation rhinoplasty at the same time or secondary to the PAHG removal. A few cases had sequelae and long time psychological stress or tend pain of nose. Conclusions The complications induced by PAHG injection for augmentation rhinoplasty are various, and may relate to the inherent character of PAHG and the anatomic features of the nasal soft tissue. Surgery can remove the PAHG as completely as possible, which is a better method to treat the complications of PAHG injection for augmentation rhinoplasty. Key words: Polyacrylamide hydrogel; Augmentation rhinoplasty; Complications

Reoperation for the Removal of Polyacrylamide Hydrogel in the Breast: Use of Periareolar Approach under Direct Visualization

Reoperation for the Removal of Polyacrylamide Hydrogel in the Breast: Use of Periareolar Approach under Direct Visualization