Author(s) Eden J.K.; Gawne S.; Dobrashian R.
Source Breast Cancer Research; 2021; vol. 23
The injectable breast filler Polyacrylamide hydrogel (PAAG) was widely used in China since the 1980s with as many as 300,000 women subjected for cosmesis and reconstruction following cancer. The procedure requires no anaesthesia, often injected by nonmedical professionals. No safety clinical trials were conducted and in 2006 the Chinese State Food and Drug Administration prohibited the clinical application following significant evidence of neurotoxic and teratogenic monomers residual in the synthesis of PAAG. Although now withdrawn, many patients are developing on-going associated complications of PAAG and presenting worldwide to surgeons unfamiliar with the treatment, necessitating complex surgery. Management of PAAG is not standardised and often directed by the radiological appearances. A case study is reported discussing the associated challenges of PAAG with recommendations gathered from the literature. Radiological imaging can mimic malignancy with inflammatory appearances, whilst simulating silicone implants and the features of Breast Implant Associated-Anaplastic Large Cell Lymphoma. Glandular atrophy and encapsulation can develop potentially delaying cancer diagnosis. Surgically, migration of the gel almost always prevents complete removal and often requires extensive reconstructive techniques. Considering PAAG may have potential toxicity and radiological interpretation is significantly compromised, careful assessment is required to understand how best to manage this group of patients often presenting with multiple complications; the long term implications are yet unknown.
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