Background: Injectable Polyacrylamide Hydrogel (PAAG) is a jelly-like biomaterial developed for use in percutaneous non-surgical cosmetic procedures in the 1980s. It was widely used as a percutaneous filler for facial and breast aesthetic procedures however safety concerns relating to infection, allergic reaction, tissue degeneration/breakdown, cosmetic asymmetry and hardening, and pain have led to PAAG being prohibited from use in most countries. Despite this, many patients globally are living with late complications following PAAG injection and present reconstructive and aesthetic challenges to the Plastic Surgeon.
Aims & Objectives: We report the case of a 52-year-old indigenous woman who presented to our service for risk reducing prophylactic mastectomy and immediate reconstruction. She had a strong family history of breast cancer and genetic testing revealed a PALB-2 oncogene mutation. The patient had undergone “Amazing Gel” PAAG breast augmentation performed 15 years prior in China with no prior reported complications.
Results: Bilateral skin sparing mastectomy was performed via inframammary incision. PAAG was noted within breast, dermis, pectoralis tissues, making identification of an appropriate mastectomy plane very difficult. Mastectomy weights of 256g and 153g were obtained. It was not possible to remove all PAAG. Immediate reconstruction was performed with pre-pectoral smooth round implants and total wrapping with Acellular Dermal Matrix. Delayed wound healing and matrix integration was noted on the Right breast, requiring return to theatre at 3 weeks postoperatively for debridement and washout. Ultimately an excellent cosmetic result was achieved once healed.
Discussion & Conclusion: We report a challenging reconstructive case for a patient requiring bilateral mastectomy following PAAG breast augmentation. The authors believe that many patients will require mastectomy with a prior history of PAAG augmentation over the next decade with an associated increased risk of perioperative wound healing and infective complications.