Delayed active bleeding after radical evacuation of injected polyacrylamide hydrogel and immediate implant based breast reconstruction

BACKGROUND Polyacrylamide hydrogel (PAAG) was used in breast augmentation surgery in China during 1997-2006. Its application has led to increasing complications such as localized lumps, asymmetry, diffuse stiffness, infections, and localized tenderness or myalgia. Hence, many patients have sought for surgical gel evacuation in the following years. CASE PRESENTATION A 37-year-old G2P0A2 slim (BMI = 18.3) woman who had received injected PAAG bilateral breast augmentation in China 15 years ago, visited our hospital for gel removal due to left upper quadrant breast tenderness with burning sensation. We performed simple mastectomy and immediate breast augmentation with silicone prostheses. Her postoperative course was uneventful. However, subcutaneous hematoma formed right after she started breast massage on the day 14 post operatively. The patient promptly received a CT-guided drainage followed by exploratory surgery with coagulation of the lesion located at the second intercostal space 2 cm to the right of the sternum. DISCUSSION Delayed bleeding in our patient might be contributed to below reasons. First, the usage of PAAG might cause degeneration of muscle tissue structure which made it more fragile than normal muscle tissue. Secondly, the lack of sufficient coverage, cushion and protection of the muscle tissue in slim patient in addition to the external compression and shearing force of massage. CONCLUSION In slim patients, we suggest that the postoperative breast massage should be postponed for months until the tissue is recovered, or delayed breast reconstruction could also be considered.