| Background and ObjectivePolyacrylamide hydrogel(PAAG)is a kind of filling material that has been applied to human body.It has been widely used in China for breast augmentation.Since 1997,"Interfall" has been introduced into China and the domestic "Amazingel" has been popular for more than 20 years,and more than 300,000 women have been treated with PAAG injection breast augmentation..With the passage of time,patients with PAAG injection augmentation have begun to have different degrees of complications,such as pain,swelling,displacement,enlargement and other clinical symptoms,which seriously endanger their physical and mental health,and also have adverse effects on families and society.At present,there is no systematic and clear literature report on the clinical characteristics and systemic diagnosis and treatment of long-term complications of PAAG injection breast augmentation.This paper aims to analyze the clinical characteristics and diagnosis and treatment of long-term complications of polyacrylamide hydrogel injection breast augmentation patients,to provide a reference for optimized treatment options of long-term complications of polyacrylamide hydrogel injection breast augmentation patients.MethodsRetrospective analysis of 29 patients who were diagnosed with polyacrylamide hydrogel injection augmentation surgery for more than 10 years from January 2014 to December 2018 in the Department of Plastic Surgery,the First Affiliated Hospital of Zhengzhou University,all women,and the clinical data of 24 patients with a total of 48 breasts were successfully collected.The youngest of them is 28 years old,the largest age is 56 years old,and the average age is 40.9 years old.Polyacrylamide hydrogel injection augmentation time varies from 10 to 20 years.Successful follow-up of 24 patients,the follow-up rate of 82.8%,the longest follow-up period of 60 months,the shortest 3 months.All the 24 patients underwent medical history collection and specialist examination,bilateral breast color Doppler ultrasound and T3.0 MRI before surgery;26 breasts of 14 patients were treated with endoscopically assisted injection of the injected material;Ten patients with 19 breasts underwent conventional open surgery through the inferior breast incision and retained the gland to remove the intramammary injection material;3 patients with 3 breasts were treated with simple mastectomy.Among them,8patients underwent puncture placement of the drainage tube before surgery.The tissues taken from the operation were sent to routine pathological examination.All patients underwent an evaluation of the surgical outcome of the patients.The content was mainly a questionnaire including the degree of symptom relief.Results1.Among the 24 patients,10 were foreign body sensation,9 were painful,and 5 were sensation of swelling.There were 11 abnormalities in breast shape and 13 cases of abnormal breast shape(11 cases of PAAG shift and 2 cases of abnormal breast volume,3 patients were displaced to the abdominal wall among them).Ultrasound showed that 14 patients(28 breasts)were injected in the posterior space of the breast;9 patients(18 breasts)were injected in the posterior mammary gland and breast tissue;1 patient(2 breasts)was injected with diffused material.Two or more sites in the subcutaneous fat layer,the gland layer,the pectoralis major layer,and the chest wall.Three of the patients were injected with the material into the ipsilateral abdominal wall,located under the fat layer and in front of the rectus abdominis.MRI showed that the patient’s polyacrylamide hydrogel showed "prosthetic type" in 14 cases(27 breasts)in the patient’s breast;8 cases(15 breasts)showed "limited type";2 cases(3 breasts)were "diffuse type";3 cases(3 breasts)were "systemic type".According to Tang Xiaoping’s classification method: 0 grade: 3 cases,grade I: 9 cases,grade II: 7 cases,grade III: 5 cases.Under the endoscope,PAAG showed "sand" and "hairy" shape.After the PAAG was taken out,"cavity and tunnel" were formed.The wall of the capsule showed "spotted" and "moss"-like tissue degeneration and hyperplasia,and severe lesions showed a "camp"-like mass protruding into the cavity with milky white "cloud"-like fibrosis.Pathology showed that the pathological tissues of 24 patients had different degrees of fibrous tissue hyperplasia,and found multinucleated giant cells,macrophages,and a small amount of neutrophil infiltration,lymphocytes are rare.The blue-stained amorphous injection was distributed between fat,gland and muscle tissue,and the vitreous degeneration occurred in 3 cases of pectoralis major cells.2.There were 21 "prosthetic type",3 "limited" breasts and 2 "systemic" breasts in 24 patients with 48 breasts who underwent endoscopically assisted injection.In one patient,the bilateral breasts were intubated after endoscopic removal and the symptoms were not completely relieved after 6 months of secondary breast resection.Symptoms of the remaining symptomatic patients disappeared,and asymptomatic patients showed no new symptoms other than breast shape changes,There were 6 "prosthetic type",12 "limited type" and 1 "systemic type" breasts with traditional open surgery through the inferior breast infusion of the gland,all of which were cured; Three "diffuse type" breasts with simple mastectomy have symptoms and healed after surgery.One patient underwent bilateral breast resection after simple resection for 6 months after bilateral breast silicone prosthesis augmentation.Conclusions1.MRI examination is helpful for the clinical classification of PAAG injection breast augmentation patients.Accurate clinical classification has important guiding significance for clinical treatment.2.Ultrasound plays an important role in the localization and preoperative pretreatment of PAAG,providing a basis for standardized diagnosis and treatment.3.This clinical study found that PAAG injection breast augmentation patients under the endoscopic changes of flocculated plaques,mossy induration,fibrosis,cavities and exposed blood vessels.4.This clinical study found that PAAG focal breast tissue showed changes in fibrous tissue hyperplasia,hyalinosis,and calcification. |
