Clinical Analysis Of Surgical Removal Of Polyacrylamide After Breast Augmentation By Difference Incisions

Objectives: In order to accumulate clinical experience,this study aims to analyze the symptom relief and scar of patients underwent surgical removal of polyacrylamide after breast augmentation by different incisions.Methods: A total of 114 patients with 228 breasts were enrolled in the Department of Burns and Medical Cosmetic Surgery of the First Affiliated Hospital of Chongqing Medical University from January 1,2010 to November 30,2019.All of them were female.Baseline data were collected,including gender,age,medical history and disease characteristics,to analyze the characteristics of disease onset and disease characteristics.From January 1,2013 to November 30,2019,41 patients with 82 breasts were collected for PAHG removal.According to the surgical approaches,patients were divided into inframammary fold incision group(group A)with 17 cases,half ring under areola incision group(B group)with 24 cases.Two Follow-up groups were compared by injection clearance,postoperative complications(pain,scleroma,displacement),incision scarring and satisfaction.The differences between two groups were analyzed by the Mann-Whitney U test,chi-square,and Fisher’s exact test.Results: Among 114 patients,the mean age was 50.2 years old(35～68years old),and the mean age of injection was 15 years(8～22 years old).The postoperative complications of PAHG injection include pain in 80 patients,mass in 47 patients,displacement in 20 patients,mass in 9 patients with pain,and 72 patients were asymptomatic but requiring to be removed due to psychological burden.196 breasts of 98 patients underwent color Doppler ultrasound examination,a large anechoic area could be seen between mammary gland and greater pectoral muscle,while some with injectant in muscle(4),injectant in mammary gland(16),injectant only in fat(2),injectant extending to bilateral axillary(4),mammary duct expansion and calcification(2),bilateral axillary lymph node enlargement(14),injectant displacement(10),mammary gland with abnormal echo(34).Postoperative pathologic results of patients(52 cases)reported that blue-stained material without structure was found,with foreign multinucleated giant cells(12 cases),foreign body granuloma(16 cases),cholesterol(4 cases),hyaline degeneration of fibrous tissue(2 cases),calcification(4 cases),hyaline degeneration(4 cases),fibrous tissue hyperplasia(4 cases),fibrous tissue hyperplasia with numerous foamy tissue infiltration(2 cases),hemorrhage and necrosis(4 cases).Cell dysplasia or carcinogenesis was not found in 52 patients,and no malignant changes were found in the remaining 62 patients’ s reports.There was no significant relationship between the preoperative complications and the probability of inflammatory response in the test(P=0.550,X~2=0.358).The average age of the 41 follow-up patients was 50.2 years old(35～62 years old),and the average time after injection was 15 years(8 ～22years).The incidence of complications was 78.1%,among which the incidence of pain was the highest,up to 35.4%.The incidence of postoperative complications in group A(58.8%)was lower than that in group B(64.7%),and there was no statistical difference between the two groups(X~2=0.168.P=0.628).The postoperative pain relief rate of group A(88.9%)was lower than that of group B(90.0%).Scleroma elimination rate in group A(25.0%)was lower than that of group B(45.5%),displacement elimination rate in group A(100.0%)was higher than that of group B(75.0%).The median surgical satisfaction score of group A(97 points)was higher than that of group B(80 points).The median self-appearance satisfaction score of group A(80 points)was equal to that of group B(80points);The above differences were not statistically significant(P pain=1.000,P mass =0.633,P displacement =1.000,P operation =0.515,P appearance =0.758).Postoperative scar was scored by Vancouver scoring scale.Group A(median =4.000)was higher than group B(median =1.000),and the difference was statistically significant(P=0.000).Conclusions: No obvious malignant changes were observed after Long-term implantation of polyacrylamide hydrogel in human body,but it could lead to surgical complications and immune reactions in tissues,so the injectant should be removed as soon as possible to avoid further adverse effects.There were no statistical differences in postoperative complications,symptom remissions,satisfaction for themselves and the operation,and postoperative color ultrasound residual rate between the half ring under areola incision and the inframammary fold incision.However,compared with the scar after surgery,the half ring under areola incision was concealed and the scar was less obvious than that of the inframammary fold incision,which was recommended.