Complications from injectable materials used for breast augmentation

Abstract

Fewer surgical procedures have a history as fascinating and as terrifying as breast augmentation. Initial efforts at augmentation involved injection of substances such as paraffin or oil into the breast tissue, or the implantation of substances including ivory or glass balls, or rubber. More recent efforts have included the injection of liquid silicone or polyacrylamide hydrogel. The current paper reviews four distinct eras of breast augmentation, and provides the current status of these injection materials. A case report is presented on a woman whose breasts were injected with polyacrylamide hydrogel in Iran. The current status of this group of materials is also presented. During the past 110 years, history has repeated itself during each of the four eras of injection.

Keywords: Breast; Injectable; Liquid silicone; Paraffin; Polyacrylamide hydrogel.

Figure 1)

Warming chamber for liquefaction of paraffin before injection (see reference 4)

Figure 2)

Clinical status of a woman who had received paraffin injections in the Far East 40 years previously. She has had many operations over the years, including bilateral mastectomies, to treat ulcers and fistulae. She continues to suffer from these problems

Figure 3)

Mammography following silicone injections demonstrates two possible patterns: multiple cystic masses ranging from 0.2 cm to 2.0 cm in diameter, often with calcification (A); or large areas of opacity if large volumes have been injected (B)

Figure 4)

Silicone granulomas resected from breast tissue previously injected with liquid silicone

Figure 5)

Histology of hematoxylin and eosin staining of the tissue shown in Figure 4. There is extensive involvement of the breast tissue by silicone, which appears as empty spaces or vacuoles filled with silicone. There are occasional multinucleated giant cells, areas of vascular obliterans, chronic inflammation, and destruction of breast parenchyma (original magnification ×50)

Figure 6)

This woman received silicone injections to her breasts in San Francisco in 1972. Over time, much of the silicone has migrated to her abdomen

Figure 7)

Computed tomography scan of the patient in Figure 6. Only a small amount of the silicone, which was initially injected into patient’s breasts, currently remains in that location

Figure 8)

Breast appearance one year after polyacrylamide hydrogel injection into both breasts in Iran. There is a visible mass in the inframammary area of the left breast

Figure 9)

Visible and palpable masses are most apparent in the inframammary and inferior-lateral areas of the left breast, particularly when the left shoulder is abducted

Figure 10)

A T1-weighted image of the left breast with low signal intensity material, mostly superficial to the pectoral muscles, in the subglandular plane. B T2-weighted image of left breast with high intensity material, mostly in the subglandular plane. C T1-weighted image of the right breast with low signal intensity material, mostly deep to the pectoral muscles. D T2-weighted image with high signal intensity material, mostly deep to the pectoral muscles, with only a small amount in the subglandular plane, inferiorly

Figure 11)

The polyacrylamide hydrogel was removed through bilateral inframammary incisions. It was easily expressed out of the pockets

Figure 12)

The polyacrylamide hydrogel had the consistency of Cream of Wheat

Figure 13)

World Health Organization stain section of the capsule around the injected polyacrylamide hydrogel material. The interface surface of the capsule (at top of image) is covered by a row of mono-nuclear and multinucleated histiocytes. These cells are supported by multiple layers of collagenous fibrous tissue. On the surface of the capsule and within the capsule, there are pools of amorphous, nonbirefringent, granular, foreign material (original magnification × 12.5)

Figure 14)

World Health Organization stain of a pool of foreign material within the capsule. The pool within the capsule is lined by attenuated, stretched out, multinucleated giant cells (original magnification × 250)

Figure 15)

Final appearance of breasts six months after the insertion of bilateral, 300 mL, subglandular Moderate Plus Profile Mentor Elite Gel implants (Mentor Canada)