Delayed breast reconstruction after breast augmentation with Polyacrylamide gel. Experience of the P.A. Herzen Moscow Oncology Research Institute

   Purpose of a study: to analyze literature review and optimization of surgical treatment of patients with delayed complications developed after polyacrylamide gel injection.

   Material and Methods. Patient B., 52 years old, came to the P.A. Herzen Moscow Oncology Research Institute with complaints about asymmetry and deformity of the breast after polyacrylamide gel injection in 1995. Instrumental examination revealed multiple heliomas and oleogranulomas in the right and left breasts. According to the results of pathomorphologic examination there was a picture of pronounced chronic inflammation with abscessing. Surgical treatment was performed in the scope of bilateral skin-preserving mastectomy with free nipple areola complex transplantation with the subsequent delayed reconstruction in combination with the Silimed endoprosthesis with the volume of 290 ml.

   Results. The optimal aesthetic outcome of breast reconstruction after polyacrylamide gel removal was obtained.

   Conclusion. Taking into account the danger of polyacrylamide gel injections, its complete removal with the expansion of the operation volume up to subcutaneous or skin-preserving mastectomy with the possibility of delayed reconstruction is recommended.

1. Unukovych D., Khrapach V., Wickman M., Liljegren A., Mishalov V., Patlazhan G., Sandelin K. Polyacrylamide gel injections for breast augmentation: management of complications in 106 patients, a multicenter study. World J Surg. 2012 Apr;36(4):695-701. doi: 10.1007/s00268-011-1273-6; PMID: 21932147.

2. Lipatov K.V., Struchkov Yu.V., Komarova E.A., Nasibov B.Sh. Post-Implantation Polyacrylamide Mammary Syndrome: a Topical Problem of General Surgical Hospitals. Novosti Khirurgii. 2016 Jul-Aug;24(4):401-406. (In Russ.). doi: 10.18484/2305-0047.2016.4.401

3. Zou H., Mo R., Wang S., Yan X., Lin Y., Tan Q. Analysis of breast follow-up results in patients after polyacrylamide hydrogel (PAAG) or silicone prosthesis removal. J Plast Reconstr Aesthet Surg. 2023 Feb; 77: 219-227. doi: 10.1016/j.bjps.2022.11.063 Epub 2022 Dec 7. Erratum in: J Plast Reconstr Aesthet Surg. 2024 Apr;91:46. doi: 10.1016/j.bjps.2023.06.046 PMID: 36587477

4. Volchenko A. Breast reconstruction after the introduction of polyacrylamide gel. (In Russ.). https://drvolchenko.ru/about/head/

5. Osmanov E.G., Shulutko A.M., Krylov A.Yu., Gandybina E.G., Malyugina A.Yu. Polyacrylamide mammary syndrome – specificity of the histological pattern of the focus before and after air-plasma treatment. Rossiyskiy meditsinskiy zhurnal – Russian Medical Journal. 2021;27(3):247-255. (In Russ.). doi: 10.17816/0869-2106-2021-27-3-247-255

6. Qian B., Xiong L., Guo K., Wang R., Yang J., Wang Z., Tong J., Sun J. Comprehensive management of breast augmentation with polyacrylamide hydrogel injection based on 15 years of experience: a report on 325 cases. Ann Transl Med. 2020 Apr;8(7):475. doi: 10.21037/atm.2020.03.68 PMID: 32395519; PMCID: PMC7210124.

7. Patlazhan G., Unukovych D., Pshenisnov K. Breast reconstruction and treatment algorithm for patients with complications after polyacrylamide gel injections: a 10-year experience. Aesthetic Plast Surg. 2013 Apr;37:312-20. doi: 10.1007/s00266-012-0045-5 Epub 2013 Feb 5. PMID: 23381651

8. Xi T.F., Fan C.X., Feng X.M., Wan Z.Y., Wang C.R., Chou L.L. Cytotoxicity and altered c-myc gene expression by medical polyacrylamide hydrogel. J Biomed Mater Res A. 2006 Aug;78(2):283-90. doi: 10.1002/jbm.a.30619 PMID: 16637045.

9. Virk-Baker M.K., Nagy T.R., Barnes S., et al. Dietary acrylamide and human cancer : a systematic review of literature. Nutrition Cancer. 2014;66:774-90.

10. Cattelani L., Polotto S., Arcuri M.F., et al. One-Step Prepectoral Breast Reconstruction With Dermal Matrix-Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation. Clinical Breast Cancer. 2018;18:e703-11.