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Polyacrylamide Gel Injections for Breast Augmentation: Management of Complications in 106 Patients, a Multicenter Study

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Abstract

Background

Polyacrylamide gel (PAAG) was first manufactured in Ukraine in the late 1980s and introduced as a biomaterial for “breast augmentation without surgery.” Since it is prohibited in most countries, PAAG injections are rare nowadays, but their consequences and long-term complications can be crucial.

Methods

We identified 106 patients consecutively operated on for PAAG complications at three teaching Ukrainian hospitals between 1998 and 2009. All relevant sociodemographic, clinical, and treatment characteristics were collected. Forty-five (42%) patients were available for clinical follow-up.

Results

The majority (88%) had had bilateral PAAG injections. The mean volume of injected PAAG was 230 ml/breast (range = 50–400). Mean age at injection was 29 years (range = 17–49) and the mean time from the injection to complications was 6.1 years (SD = 4.1). Symptoms preceding debridement were pain in 85 patients (80%), breast hardening in 79 (74%), breast deformity in 77 (73%), lumps in 57 (54%), gel migration in 39 (37%), fistulas in 17 (16%), and gel leakage in 12 (11%). The surgical interventions in 199 breasts included gel evacuation alone in 107 (54%) or in combination with partial mastectomy in 65 (33%), partial mastectomy and partial pectoralis muscle resection in 12 (6%), or subcutaneous mastectomy in 15 (7%). Of the 199 operated breasts, 86 (43%) immediate and 58 (29%) delayed implant-based breast reconstructions were performed.

Conclusion

Injections of PAAG can cause irreversible damage to the breast necessitating complex debridement procedures, even mastectomy and breast reconstruction. Despite numerous surgical interventions, gel remnants are still found on subsequent breast imaging. Although PAAG is prohibited in many countries, different types of injections with unknown long-term effects are currently being used. Making the public aware of the problems of injectables for breast augmentation is warranted.

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Authors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Dmytro Unukovych, Marie Wickman & Kerstin Sandelin

  2. Department of Surgery #4, National O.O. Bohomolets Medical University, Kiev, Ukraine

    Dmytro Unukovych, Vasyl Khrapach & Volodymyr Mishalov

  3. Department of Reconstructive Plastic Surgery, Oleksandrivska City Clinical Hospital, Kiev, Ukraine

    Vasyl Khrapach

  4. Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden

    Marie Wickman

  5. Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden

    Annelie Liljegren

  6. Department of Oncology, Karolinska University Hospital, Stockholm, Sweden

    Annelie Liljegren

  7. Department of Reconstructive and Aesthetic Medicine, Odessa State Medical University, Odessa, Ukraine

    Gennadiy Patlazhan

  8. Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden

    Kerstin Sandelin

Authors
  1. Dmytro Unukovych
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  2. Vasyl Khrapach
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  3. Marie Wickman
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  4. Annelie Liljegren
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  5. Volodymyr Mishalov
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  6. Gennadiy Patlazhan
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  7. Kerstin Sandelin
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Corresponding author

Correspondence to Dmytro Unukovych.

Additional information

Presented as an oral presentation at the International Surgical Week (ISW 2011), August 30, 2011, Yokohama, Japan.

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Unukovych, D., Khrapach, V., Wickman, M. et al. Polyacrylamide Gel Injections for Breast Augmentation: Management of Complications in 106 Patients, a Multicenter Study. World J Surg 36, 695–701 (2012). https://doi.org/10.1007/s00268-011-1273-6

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  • DOI: https://doi.org/10.1007/s00268-011-1273-6

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