title: Polyacrylamide gel injections for breast augmentation: management of complications in 106 patients, a multicenter study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. dmytro.unukovych@ki.se
authors.forename: Dmytro
authors.initials: D
authors.lastname: Unukovych
authors.forename: Vasyl
authors.initials: V
authors.lastname: Khrapach
authors.forename: Marie
authors.initials: M
authors.lastname: Wickman
authors.forename: Annelie
authors.initials: A
authors.lastname: Liljegren
authors.forename: Volodymyr
authors.initials: V
authors.lastname: Mishalov
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Patlazhan
authors.forename: Kerstin
authors.initials: K
authors.lastname: Sandelin
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials; D001941:Breast Diseases / Q000209:etiology / Q000601:surgery*; D003646:Debridement; D005260:Female; D006801:Humans; D007267:Injections; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D055815:Young Adult
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials; C016680:polyacrylamide gels