Long-term Complications from Breast Augmentation by Injected Polyacrylamide Hydrogel

267 simultaneous occurrence with a malignant giant cell tumor of soft parts. Cancer 1993;72:462-8. 3. Morrison AE, Lang PG. Case of rapidly enlarging Dermatofibrosarcoma protuberans during pregnancy followed by metastasis in the absence of local recurrence. Dermatol Surg 2006;32:125-7. 4. Angouridakis N, Kafas P, Jerjes W, et al. Dermatofibrosarcoma protuberans with fibrosarcomatous transformation of the head and neck. Head Neck Oncol 2011;3:5. 5. Lee SH, Choi SW, Jin US, et al. Outcomes of surgery for dermatofibrosarcoma protuberans and risk factor analysis for recurrence. J Korean Soc Plast Reconstr Surg 2011;38:609-15. complications ten years after the injection. A number of articles have reported complications of PAAG injection for aesthetic purposes, but it was difficult to find any Korean reports on complications that have occurred as long as ten years after breast augmentation with PAAG. The patient presented with breast lumps, which had developed six months earlier. The lumps were palpable in two locations: at the upper outer part of the right breast and at the center of the chest between the breasts. The patient had undergone filler injection for breast augmentation ten years earlier at a local clinic in Shenyang, China. The patient only remembered a filler material called Amazingel was used, but did not recall the quantity of the material injected. Through a tracing investigation, we determined that Amazingel was a PAAG-type of filler material manufactured in China. During physical examination, symptoms such as tenderness and a burning sensation were not observed around the lumps, and there was no discomfort other than contour abnormalities resulting from the lumps. A preoperative magnetic resonance imaging (MRI) scan revealed fluid-filled sacs in the retroglandular areas of both breasts, and part of the contents appeared to have leaked out of the capsules (Fig. 1). The MRI images showed filler material with a low signal on T1 weighted images and a high signal on T2 weighted images. PAAG consists of a large quantity of water and has a tendency to appear dark in T1 weighted images and bright in T2 weighted images [1]. The author performed breast implant removal surgery under general anesthesia. Two stab incisions were made in the inframammary folds of the breasts, and dissections were made below the mammary glands. A yellow, granular jelly-like substance was drawn out by breaking off the fibrous capsules (Fig. 2). The foreign substance was extirpated as much as possible by can-