Radiologic Findings of Polyacrylamide Gel Mammoplasty and Its Complications: A Report of Four Case Series and Review of Literature

Kim Jong Hee,Hwang Ji-Young,Moon Jin Hee,양익,Woo Ji Young 대한영상의학회 2022 대한영상의학회지 Vol.83 No.1

Polyacrylamide gel (PAAG) has been used for augmentation mammoplasty in certain countries, such as China or Eastern European countries. However, owing to various complications, its use is currently banned in most countries. Nevertheless, because of the migratory stream of female from these countries, we also encounter patients with PAAG mammoplasty in Korea. Owing to the various imaging features of PAAG mammoplasty, it may interfere with the identification of malignancy or other pathologic conditions. Therefore, it is important to identify the imaging findings related to PAAG mammoplasty. However, there is limited literature on the radiologic findings of complications related to PAAG mammoplasty in Korea. Herein we report four cases of PAAG mammoplasty, the complications faced, and depict various radiologic features through multimodality imaging.

유륜절개 접근법을 이용한 유방 축소술 : 중심피판경과 하부진피피판경의 비교

한상훈,조종한,이상민,남상재 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

After the introduction of the central parenchymal pedicle by Hester(1985) and the round-block technique by Benelli (1988), several variations of periareolar reduction mammoplasty have been used by many authors. Periareolar reduction mammoplasty is a less aggressive procedure than traditional techniques and it produces less conspicuous periareolar scars while maintaining an acceptable overall result. We experienced 120 cases (60 patients) of periareolar reduction mammoplasty during the period from May 1994 to February 1998. We present the analysis of 60 cases of periareolar reduction mammoplasty. Periareolar reduction mammoplasty utilizing central parenchymal pedicle was performed in the first 40 patients, while a procedure utilizing the inferior dermal pedicle was done in the next 20 cases consecutively. The range of follow-up was from 1 to 5 years. Complications such as nipple areolar complex necrosis and sensory changes were reduced when the inferior dermal pedicle used. There were 5 cases of nipple areolar complex necrosis and sensory changes were reduced when the inferior dermal pedicle used. There were 5 cases of nipple areolar complex necrosis (6.2%), including 1 case of near total necrosis in cases utilizing the central parenchymal pedicle. But in the technique using inferior dermal pedicle, there was no skin flap necrosis. The central parenchymal pedicle technique has several advantages such as a wide operation field permitting complete breast contouring and better mobility of the remaining breast tissue. However, inferior dermal pedicle technique has relative superiority over central parenchymal pedicle technique in terms of anatomical rationale, as well as in the rate of complications without causing limitations in breast mobility for contouring. Such complications as nipple areolar complex necrosis, skin flap necrosis and sensory change of nipple were reduced when the inferior dermal pedicle technique was used. It is much easier to preserve the 4th intercostal nerve to the nipple anatomically. Periareolar reduction mammoplasty utilizing the inferior dermal pedicle is thought to be a reliable, reproducible method.

하이브리드 가슴확대술

박성수,석정훈,이정우 대한미용성형외과학회 2012 Archives of Aesthetic Plastic Surgery Vol.18 No.2

Natural look of breast after augmentation mammoplasty is a common end of both plastic surgeons and patients. Palpability and visible rippling after augmentation mammaplasty is not a simple complication to correct in relatively thin patients especially when there is not much soft tissues remain to cover the implant for smooth contour. And asymmetry of the breast in accordance with the skeletal deformity, such as pectus excavatum, can not be easily reformed with insertion of silicone implant alone. In the present study, volume enhancement was accomplished by silicone implant augmentation and contour management was improved with the help of fat graft technique. We named the technique “Hybrid Augmentation Mammoplasty”. From May 2011 to Feb. 2012, the hybrid augmentation mammoplasty procedure were performed on 9 patients who expected to have palpable implants, visible rippling or asymmetry due to their soft tissue and skeletal condition. Breast augmentation with silicone implant was done in regular pattern followed by grafting fat tissues utilizing Harvest-jet device into the pre-pectoral, sub-glandular and subcutaneous layer. During the follow-up period, any patient complained palpability of the implant and all of them were satisfied with the contour of their breast. Hereby we suggest that the hybrid augmentation mammoplasty can be an ideal,effective and useful option in management of thin skinned patients or patients with chest wall deformities.

Augmentation Mammoplasty Using Polyacrylamide Hydrogel Injection Can Mimic Breast Cancer After 20 Years: A Case Report

Soon Bo Choi,Jiyoung Kim,Dongwon Kim,Jiyoon Park,Youkyoung Lee,Kyungri Park,Eun Sil Kim,So Min Lee,Sung-Won Kim 한국유방암학회 2022 Journal of Breast Disease Vol.10 No.2

Polyacrylamide hydrogel (PAAG), an injectable, jelly-like, medical hydrogel, has been popular in some countries as a non-surgical method of mammoplasty since approximately 2000. Particularly in China, many patients underwent mammoplasty using PAAG during a 16-year period until 2006, and studies on its course and complications were also conducted. However, evidence regarding the relationship between PAAG mammoplasty and malignancy is lacking, and only a few cases have reported the possibility of this association. Herein, we present a case in which malignancy was suspected because of complications 20 years after PAAG injection mammoplasty.

Periareolar incision을 이용한 mastopexy와 reduction mammoplasty

배원배,강소라,박흥식,윤진호,김한중 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

As the general Population's interests increase in their physical, cosmetic attractiveness, The number of cases involving mammoplasty has a tendency to increase. And also various mammoplasties are newly introduced in technical aspect of mammoplasty. The main objectives of cosmetic breast surgery is to make a nice cone shaped breast with the minimum amount of scars left on the skin. In the case of reduction mammoplasty or mastopexy through periareolar incision, the areolar size increases or the shape becomes distorted Therefore, the "periareolar incision" procedure is performed only on the patients with small or moderate-sized breast. It has been reported that these problems were solved by Benelli with his "round block" method, but minor faults were also found. Authors using "mastopexy or reduction mammoplasty through periareolar incision" operated on12 patients with minor modifications compared to Benelli's method. As a result we reduced the possibility of enlargement or distortion of the nipple-areolar complex. Compared to the "round block" method, our method also reduced the area of deepithelized skin and minimized pleats around nipple-areolar complex. We also found that our method saved operation time, and was much easier to be operated. Our technique allows us to correct protrusion in the lower pole and accurately put the nipple-areola complex in position by the anchoring sutures.

유방확대술 시행시 늑간신경 차단술이 통증 완화에 미치는 영향 - MDbP 203

이상달 한국유방암학회 2006 Journal of breast cancer Vol.9 No.4

Purpose: Augmentation mammoplasty is a procedure that expands the breast tissue and pectoral muscle by insertion of an implant. This procedure induce extreme postoperative pain. The purpose of this study was to determine whether intercostal nerve block (ICNB) could reduce the pain after augmentation mammoplasty. Methods: Eighty three patients, who underwent augmentation mammoplasty, at the M.D. Clinic between December 2005 and February 2006, were the cases of this study. We injected 0.25% ropivacaine (total 30ml per side) in the ICNB group (n=68) into the 3,4,5 and 6th intercostals spaces following induction of general anesthesia for surgery. The mean arterial pressures and heart rates were measured before and after subpectoral dissection. A numerical rating scale (NRS: 0=no pain, 10= most severe pain) was used to measure the pain postoperative 6, 24, 48 hours, respectively. We statistically compared the ICNB group with the control group (n=15) with using the Mann-Whitney Rank Sum test. Results: The mean arterial pressures and heart rates were more stable during subpectoral dissection in the ICNB group than in the control group (p= 0.142 and p= 0.037). The NRSs were lower throughout the 48 hours of the postoperative period in the ICNB group than in the control group (p<0.001 at 6hr, p=0.017 at 24hr, p=0.054 at 48hr). Conclusion: ICNB induced stable vital sign during subpectoral dissection and excellent postoperative pain control during 48 hours postoperatively for those patients undergoing augmentation mammoplasty.

폴리아크릴아미드 겔을 이용한 유방확대술의 초음파 및 유방촬영술 소견: 증례 보고

김재원,최선형,정수영,양익,윤세라 대한초음파의학회 2009 ULTRASONOGRAPHY Vol.28 No.3

Polyacrylamide gel has been widely used for soft tissue contouring for more than 30 years and has been used for breast mammoplasty augmentation in China since 1997. As Korea is close to China, Korean clinicians often encounter the patients who have undergone polyacrylamide gel augmentation mammoplasty. Therefore, radiologists should know the ultrasonographic and mammographic findings and the complications of polyacrylamide gel augmented mammoplasty; this can be helpful in the diagnosis and management of those patients. We report the characteristic radiological findings of a patient who had undergone mammoplasty augmentation with polyacrylamide gel. 폴리아크릴아미드 겔은 30년 이상 연조직 성형에 광범 위하게 사용되어 왔으며, 1997년 이후로 중국에서 유방 확대성형에 이용되어 왔다. 우리나라는 중국과 인접해 있 어 유방영상 검사 시 폴리아크릴아미드겔로 유방확대술을 시행받은 환자를 접하는 일이 잦다. 따라서 영상의학과 의 사는 폴리아크릴아미드겔을 사용한 유방확대술의 초음파 및 유방촬영술 소견과 합병증에 대해서 알아야 하며 이는 이런 환자들의 진단과 치료에 도움을 줄 수 있다. 우리는 폴리아크릴아미드겔을 이용한 유방확대술을 시행받은 환 자의 특징적인 영상 소견을 보고하고자 한다.

폴리아크릴아마이드 겔을 이용한 유방확대술의 초음파 소견: 3 증례 보고

최재정,강봉주,이재희,김성헌 대한초음파의학회 2009 ULTRASONOGRAPHY Vol.28 No.2

Polyacrylamide gels (PAAGs) have been widely used for breast augmentation in China and the former Soviet Union since the 1990s. However, breast injection of PAAGs was abandoned due to various complications such as induration and lumps. Currently, this injection procedure is illegally practiced in South Korea and there are a few reports on the radiological findings of PAAG injection mammoplasty, especially describing the sonographic features. We report three cases of PAAG injection mammoplasty. 폴리아크릴아마이드 겔은 1990년대부터 유방확대의 목적 으로 주로 중국과 소련에서 사용되었으나 유방 종괴와 동통 등 의 합병증이 보고되면서 현재 거의 사용되지 않고 있다. 그러 나 국내에서 비합법적으로 아직 시행되고 있으며 중국에서 시 술 받고 온 환자들도 있다. 이에 대한 영상의학적 소견, 특히 초음파 소견을 보고한 문헌이 적어 정확한 진단이 어려운 경우가 많다. 저자들은 유방 초음파, 유방 촬영술과 자기공명 영상 을 시행한 폴리아크릴아마이드 겔 유방확대술의 세 증례를 보 고하고자 한다.

유륜둘레 절개법을 이용한 유방확대 수술

이은정 대한미용성형외과학회 2009 Archives of Aesthetic Plastic Surgery Vol.15 No.2

The periareolar approach provides central acess to all quadrants of the breast and is compatible with all the various breast implants and planes. This approach is also the choice when considering or planning a simultaneous mastopexy, and is also useful for dual plane dissection. Although the diameter of the areola is a limiting factor when contemplating this approach, areolas as small as 25mm in diameter will allow for creation of a 4-cm incision along one half of the areola circumference. The incision along the areola can also be lengthened by a zig-zag W incision. The damage of the breast parenchyme can be minimizes by making inferior subcutaneous dissection 3-4cm apart from the periareolar skin incision. The lateral edge of the pectoralis major can be identified and lifted easily after vertical cutting of breast parenchyma. The submammary or submucular pocket can be made accurately without difficulty by using blunt dissection or sharp electrocautery dissection. The bleeders are also cauterized easily with good visual field. The lateral branch of the 4th intercostal nerve can be identified and avoided from damage with direct vision. This approach is also effective in removing thick capsule after augmentation mammoplasty. The inferior portion of the pectoralis major is also cut along the inferior margin of the breast for dual plane dissection. The periareolar scar could be minimal by making W-shaped zig zag incision along a irregular skin areolar junction after making nonabsorbable mersilen intradermal suture to prevent scar widening.

코헤시브 실리콘 젤 유방삽입물을 이용한 유방확대술 후 발생한 유방삽입물의 흉강내로의 이탈 및 파열 증례보고

이준용,김한구,김우섭,박보영,배태희,최주원 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: Breast implant ruptures and displacement are problematic complications after augmentation mammoplasty. The authors report a patient whose cohesive silicone gel implant ruptured and migrated into the pleural cavity after augmentation mammoplasty. Methods: A 23-year-old female had received augmentation mammoplasty at a local clinic a week before visiting our hospital. When the patient’s doctor performed a breast massage on the sixth postoperative day, the left breast became flattened. The doctor suspected a breast implant rupture and performed revision surgery. The implant, however, was not found in the submuscular pocket and no definite chest wall defect was found in the operative field. The doctor suspected implant migration into the pleural cavity, and after inserting a new breast implant, the doctor referred the patient to our hospital for further evaluation. The patient’s vital signs were stable and she showed no specific symptoms except mild, intermittent pain in the left chest. A CT scan revealed the ruptured implant in the left pleural cavity and passive atelectasis. Results: The intrapleurally migrated ruptured implant was removed by video-assisted thoracic surgery (VATS). There were no adhesions but there was mild inflammation of the pleura. No definite laceration of the pleura was found. The patient was discharged on the first day after the operation without any complications. Conclusion: Surgeons should be aware that breast implants can rupture anytime and the injury to the chest wall, which may displace the breast implant into the pleural cavity, can happen during submuscular pocket dissection and implant insertion.