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Objective@#To study the expression of TNF-α and PCNA in human breast tissue with polyacrylamide hydrogel(PAHG) injection, and to provide the initial theory basis for its prognosis and clinical treatment.@*Methods@#Immunohistochemistry was used to measure the expression of tumor necrosis factor α(TNF-α)and proliferating cell nuclear antigen (PCNA) in 20 normal breast tissues and 40 cases with PAHG injection, analysis was also done by HE staining.@*Results@#①HE staining showed that there were a large number of homogeneous amorphous gel-like injections under optical microscope. Around PAHG there were different degrees of fibrous tissue hyperplasia with or without fibrous degeneration and lots of inflammatory cells. Local foreign body giant cell reaction and ductal dilatation also can be seen around PAHG. ②The IA levels of TNF-α and PCNA in the experimental group were 3.9± 0.3 and 3.2 ± 0.2, the IA levels of TNF-α and PCNA in the control group were 1.0 ± 0.1 and 1.3 ± 0.3, the IA level in the experimental group was significantly higher than that in the control group (P=0.000). The difference was statistically significant. The positive rates of TNF-α and PCNA in the experimental group were 90% (36/40)and 85% (34/40)respectively; the positive rates of TNF-α and PCNA in the control group were 30% (6/20), 40% (8/20). The positive expression rate in the experimental group was significantly higher than that in the control group (P=0.000). The difference was statistically significant. TNF-α and PCNA has Pearson positive relevance in the changes(r=0.3, P=0.040), the difference was statistically significant.@*Conclusions@#TNF-α and PCNA are involved in the immunoreaction of mammalian breast tissue injected with polyacrylamide hydrogel, which may induce the aseptic inflammation, fibrous tissue hyperplasia and related issues through mutual influence.
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Objective To study the pathological mechanism of aseptic necrosis of breast tissue after long-term breast augmentation injected with polyacrylamide hydrogel (PAHG).Methods We included patients who had no obvious clinical symptoms and underwent surgical removal of the PAHG in our hospital,excluding patients with a history of breast prosthesis implantation.Extracts were collected,and then underwent a careful gross observation and serial sections followed by HE,Mallory,and toluidine blue staining,to observe the histological structure of collagen fibers and inflammatory cells.Immunohistochemistry for CD31 and a-smooth muscle actin (a-SMA) antibody was used to further identify vascular endothelial cells and vascular smooth muscle cells,respectively.Analysis of the correlation between injection time and the incidence of different pathological changes were done.Results We included 22 females (mean age 39.14 years,range 22-55 years) who requested surgical removal of the PAHG.The mean duration of PAHG injection was 9.27 years (range 4-14 years).They had no clinical symptoms or only had induration,deformation and displacement.The basic pathological changes of local tissue included foreign body reaction and chronic inflammation,fibrosis and tissue necrosis;and half of the tissue had also histological changes,such as small vascular smooth muscle layer thickening,lumen stenosis,etc.No significant correlation was found between the pathological changes and the duration of the disease and the clinical symptoms.Conclusions Patients with PAHG injection for augmentation mammoplasty can histopathological changes of local tissues even without experiencing discomfort.The tissue necrosis in some patients may be caused by foreign body reaction and inflammatory reaction.It may also be due to local ischemia caused by small vascular smooth muscle hyperplasia,luminal stenosis etc.
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Objective To investigate the efficacy of breast tissue flap cohesive treatment after breast augmentation injection mixture dis-placed.Methods A total of 78 patients with breast augmentation injection mixture polyacrylamide hydrogel(PAAG)shift in our hospital from January 2006 to March 2014 were divided into two groups according to different surgical methods,39 cases with the material shifted to abdominal wall in control group were treated by taking the cleaning operation to scrape residual cavity,39 patients in observation recieved new breast tissue flap design local treatment of breast fistula closed chest and abdominal wall channel after surgical elimination of the same abdom-inal wall cavities.Results The PAAG extensive deposition in the breast tissue,armpits,chest wall clearance were formed fistula communica-tion.The secretions of patients treated with tissue flap decreased 82%,the lacunar lesions reduced 80% after 2 weeks,while patients without tissue flap,the drain reduced 46%,the lesion size reduced 45%,the difference between the two groups was significant(P <0.01).The heal-ing rate of tissue flap group was higher than that of conventional group after 4 weeks.Conclusion The PAAG mixture shifting formed fistula communication in the abdominal wall is the main reason of the mass flow and a huge cavity.Flap can significantly promote abdominal wall fis-tula healing.
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Objective To discuss the clinical manifestation and treatment of the complications caused by injected polyacrylamde hydro-gel( PAAG) for breast augmentation. Methods This retrospective research was performed among 212 patients who undergoing breast aug-mentation with injected polyacrylamde hydrogel. The clinical manifestation and treatment outcome of the complications were analyzed and summarized,which is aim to search an effective treatment method. Results For the 212 patients,the main complications were breast multi-ple indurations (131 cases),fever (9 cases),infection (14 cases),breast pain (65 cases),PAAG displacement (28 cases) and secondary deformity or asymmetry (25 cases). 152 cases experienced one clinical symptom,the rest patients simultaneously undergone no less than two clinical symptoms. Patients were received open operation with periareolar incision ( surgery group) or vacuum absorption by needle ( aspira-tion group) for dislodging PAAG. No significant difference was found in wound healing,breast shape satisfaction and pain anesis between the two groups. Whilethe surgery group was better than the aspiration group in efficiency for taking out PAAG and the incidence of reoperation, with statistical significance. Conclusion A plenty of complications occurred after breast augmentation with injected polyacrylamde hydrogel, the method of open operation with periareolar incision is a better way for eliminating PAAG and treating the complications.
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Objective To investigate the clinical indication and effect of instant reconstruction of breast after removal of polyacrylamide hydrogel injection for breast augmentation.Methods Patients had breast ultrasound,MRI check before operation,to define the distribution and level of the injections and tissue infiltration.Depending on tissue degree,capsule integrity and breast degeneration situation,three different methods were chosen,including implantation of silicone gel underneath the breast,pectoralis major or dual-plane.Results 56 patients' incision healed well.Follow-up for 6 months to 3 years showed that breast shapes were good without scars,prosthetic herniapsular,capsular contracture and other complications.Conclusions Instant reconstruction of the breast after removal of polyacrylamide hydrogel injection can improve breast shape and get satisfied effects.
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Objective When implantation of a prosthesis is performed for patients with a local defect of the breast after the removal of polyacrylamide hydrogel,incomplete coverage of the surface of the prosthesis occurs in these cases.The aim of this study was to explore the effectiveness of acellular allogeneic dermis in the repair of defects after prosthesis implantation.Methods Breast prosthesis implantation together with acellular allogeneic dermis repair was performed in 46 cases.Acellular allogeneic dermis was applied to cover the surface of the prosthesis,and interrupted suture was used between the margin of the dermis and the incisional margin of the gland,while appropriate tension was maintained.Results There were no complications occurred postoperatively.Correction of local depression in the breast was excellent in all cases.Histological examination showed the implanted acellular allogeneic dermis was integrated into the peripheral tissue.Conclusions Acellular allogeneic dermis can be used for repairing breast and muscle defects,in order to cover the prosthesis.Although it cannot significantly increase the thickness of the subcutaneous tissue,it can maintain the integrity of the peripheral tension around the prosthesis.In this way,it can avoid bulging of the prosthesis caused by a sudden reduction of local tension.Moreover,donor site injury is avoided.Acellular allogeneic dermis is an effective method for the repair of local breast defects.
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Objective To explore the complications of augmentation mammoplasty by polyacrylamide hydrogel (PAHG) injection and their management.Methods Preoperatively,174 patients underwent breast ultrasound image,and some patients received magnetic resonance imaging (MRI) to ascertain the distribution of injected PAHG.We used the periareolar incision and dissection extended to the subcutaneous tissue,mammary gland,and subgland space.We were able to suck most of the gel by the negative pressure machine and remove the abnormal breast tissue.The secondary breast deformity was repaired with subpectoral placement of silicone mammary implants (48 cases immediately,39 cases secondarily after 3-6 months) according to the individual situation.Results Following-up for 3 to 6 months,most of their symptoms were relieved after removal of the polyacrylamide hydrogel.In the patients who were performed with the implants augmentation mammoplasty,77 cases gained satisfactory results on the shape and texture of the breast (44.3％),and 10 cases were not satisfied with texture of the breast (5.7％).79 cases appeared breast atrophy or flat chest (45.4％).The severe breast deformities occurred in 8 cases (4.6％).Conclusions PAHG should be removed with surgical operation as soon as possible.The open operative technique via periareolar incisions may be a better method for the patients.The breast reconstruction is performed with implants prosthesis for those who are suitable and willing after removal of PAHG.
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Objective To investigate the effect of superomedial pedicle mammaplasty in the treatment of the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removal.Methods Thirty-six patients underwent a new technique for mammaplasty.This technique involved a superomedial pedicle with or without Würinger's horizontal septum which was used to repair the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removed.Results In our series,the new nipple-to-sternal-notch distance was (20.10±1.94) cm postoperatively.Mean nipple elevation was 7.5 cm (range 4 13 cm),and there were no he matoma and partial or complete nipple-areolar complex (NAC) necrosis occurred.Minimal wound dehiscence occurred in two cases (5.56 ％),the rest cases were healed in stage Ⅰ.Twenty eight patients were followed up for 6 to 18 months.NAC sensibilities were comparable before and after operation,and good breast shapes were produced with unconspicuous incision scar in all cases.Conclusions Superomedial pedicle mammaplasty could achieve satisfactory results with respect to breast contouring and scar,meanwhile maintain the NAC viability and sensibility.
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Objective To investigate the reconstructive effect and method on breast deformation after polyacrylamide hydrogel injection for breast augmentation.Methods Sixty patients underwent B type ultrasonic and MRI examination for confirmation of breast deformation after removal of polyacrylamide hydrogel injection and clear distribution level of the injection material and surrounding tissue infiltration.According to skin elasticity,breast subcutaneous layer,glandular layer and pectoral muscle layer,then placed in the suction apparatus with injection of normal saline and completely sucked out and clear the injection material.Based on the wishes of patients and tissue damage,divided into Ⅰ or Ⅱ prostheses implanted and provided appropriate treatment Results Within 3 months to 3 years visiting,breast shape was good.Prosthesis had no herniation,without infection.Bilateral breasts were symmetry without capsular contracture.Conclusions Reconstruction of breast deformation after polyacrylamide hydrogel injection for breast augmentation can improve breast shape and achieve satisfactory effects.
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Objective: To study the change of immunological response and cell proliferation in breast tissues augmented by polyacrylamide hydrogel injection(PHI). Methods: The expression of CD68, CD25 and PCNA in 20 breast tissues with indurations, 12 without indurations after breast augmentation by PHI,and 10 normal breast tissues was examined by immunohistochemistry P-V6000; analysis was also done by H-E staining. Results: Hyperplasia of fibrous tissue and infiltration of inflammatory cells and macrophages were found in the breast and adjacent tissues 3-8 years after PHI. Positive cells of CD68, CD25 and PCNA hardly existed in the normal tissues, but the breast tissues around the polyacrylamide hydrogel had many positive cells of CD68 and PCNA, especially in cases with indurations; there were significant differences between the 3 groups (P<0.01); and the numbers of cells positive of CD25 were similar between the 3 groups. Conclusion: Long-term implantation of polyacrylamide hydrogel can cause immunological reaction and cell proliferation in the local adjacent tissues.
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Objective To evaluate the methods of correction for secondary deformity after removal of polyacrylamide hydrogel in breast.Methods From June 2006 to December 2007,the Center of Breast Plastic and Reconstruction at Chinese Academy of Medical Sciences admitted and treated 36 patients who experienced deformity after polyacrylamide hydrogel remoral in breasts.The average age of the patients was 27.5 years,and the time of consultation for the correction was from 6 months postoperatively.The patients who had preoperative MRI examinations showed that no visible polyacrylamide hydrogel remained in the breast were included in the study.The patients were classified according to the deformity of the breast and the chest wall tissue.Autologous fat injection grafting,silicon gel implant augmentation,and dermis grafting were performed for treating the deformity of the breasts after polyacrylamide hydrogel removal.Results During 3 to 18 months follow-up,the shape of the breast was improved and no complications such as infection,the sclerotic nodules,implant exposure occurred.35(97.2%) patients were satisfied with the result of the operations.Conclusions The correction for secondary deformity of breast after removal of PAHG should be performed at least 6 months after removal of polyacrylamide hydrogel.The optimal and nature contour of the breast may be recovered by combination of various surgical methods which are carefully selected according to the individual situation.
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Objeetive To discuss a reasonable postoperative management of breast augmentation by polyacrylamide hydrogel (PAHG) injection.Methods The retrospective study was used to analyze 157 cases which received breast augmentation by PAHG injection.MRI was used in all of cases preoperatively.Among these patients,23 were located by three-dimensional (3D) reconstruction,the content of mono acrylamide in the serum of 71 cases were examined in the hydrogel of 23 cases and in the tissue around the hydrogel of 12 cases,respectively.The silicone gel implants were planted after the removal of PAHG in 7 cases.Results MRI-3D could show the injectants location,scope,layer and integrality more intuitional and more detailed.The momo acrylamide was found in the serum with 7 cases,in the hydrogel with 5 cases,in the tissue around the hydrogel with 3 cases.131 cases gained satisfactory results.All the cases received 3 to 6 months follow-up.The scleroma was not found after the palpation of breast.In the 7 cases that were planted with the silicone gel implants immediately,the shape and texture of the breast were both great.Conclusions The preoperative MRI examination is a first-choice,and if possible,3D reconstruction is better.With the detecting methods so far,there is no strong evidence to support the possibility of PAHG resolving into poisonous acrylamide inside the human body.During the operation,the injectant,the integument around the hydrogel and degenerative tissue should be orthoptically cleared-up as much as possible.Sucking the injectant blindly is not commended.The silicon gel prosthesis is planted to reconstruct the shape of breast immediately,but the prerequisite is that the patients have this demand and that the muscle is intact without inflammation.
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Objective To explore the indication of implant prosthesis immediately after removing polyacrylamide hydrogel for augmentation mammaplasty. Methods MRI and pathologic examinations were made in 226 patients with the postoperative complications of augmentation mammaplasty by injecting polyacrylamide hydrogel and with the specific conditions in operation to analyze the possibility of implant prosthesis while removing polyacrylamide hydrogel. Based on MRI examination, physical examination and specific conditions in operation, we chosen 61 cases who requested for implant prosthesis while removing polyacrylamide hydrogel. Results The patients who did the operation for simply removing polyacrylamide hydrogel recovered well and symptoms such as pain, sclerosis, mass and others disappeared almostly; the patients who did implanting at the same time were satisfied with the breast shape and had no side-effect occured. Conclusion With MRI examination, physical examination and specific conditions in operation, it can achive good effects to do implanting immediately after removing polyacrylamide hydrogel for those suitable and willing to implant prosthesis.
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Objective To analyze the causes and explore suitable treatments for the complica-tions induced by polyacrylamide hydrogel (PAHG) injection for augmentation rhinoplasty. Methods The causes of the complications of 52 cases who accepted PAHG injection for augmentation rhinoplas-ty were analyzed and summarized. All the patients were treated by surgical operations to remove the injected PAHG. Results The complications included infection, granuloma, skin ulceration, bad shape, pain and serious psychological stress. Each case had 1 to 4 complications. Satisfactory results were obtained after suitable treatments. Some cases had silicone or expanded polytetrafluoroethylene implant augmentation rhinoplasty at the same time or secondary to the PAHG removal. A few cases had sequelae and long time psychological stress or tend pain of nose. Conclusions The complications induced by PAHG injection for augmentation rhinoplasty are various, and may relate to the inherent character of PAHG and the anatomic features of the nasal soft tissue. Surgery can remove the PAHG as completely as possible, which is a better method to treat the complications of PAHG injection for augmentation rhinoplasty.
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Objective To evaluate the significance of MRI before surgery to remove polyaeryl-amide hydrogel (PAMHG) which has been used for augmentation mammaplasty. MethodsTwenty female patients with 40 breasts, having been injected PAMHG as augmentation mammaplasty, under-went bilateral breast axial T1WI, T2WI-fat saturation (FS) and sagittal T2WI-FS by 4-channal phased-assay breast coil at 3.0T (Philips) before removal surgery, in which 8 patients underwent axial multiphase contrast-enhanced MRI with THRIVE after Gd-DTPA (2.0 ml/s, 0.1 mmol/kg) adminis- tration. The results of MRI were compared with that of operation and pathology. ResultsPAMHG showed iso-intensity compared with breast gland on T1WI and hyperintensity on T2WI-FS. Low signal septa were noted within PAMHG in 40 breasts (20 patients), 90% (36/40) PAMHG without capsule, 10 % (4/40) with smooth capsule which showing homogenous low signal on T1WI and T2WI-FS. Subcutaneous lump of PAMHG was 70 % (28/40), lump of that in breast gland was 20% (8/40). Diffuse gel along spatium intermusculare of pectoralis major was 100 % (40/40), that along spatium intermusculare of intercostal muscle was 10 % (4/40). All PAMHG in breast of the 8 patients showed no enhancement, an irregular enhanced mass was found in gland of 1 patient. All distributions of PAMHG and appearances of its complications on T2WI-FS were consistent with the results of operation. ConclusionsT2WI-FS can accurately display the distribution of PAMHG and its complication before removal surgery. MRI plane scan combined with muhiphase contrast-enhanced MRI can differentiate PAMHG from the lesions in the gland and find the breast carcinoma, so that it can guide clinicians before surgery to remove PAMHG used for augmentation mammaplasty.
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Objective: Breast augmentation by polyacrylamide hydrogel(PAHG) injection has resulted in a series of adverse events in many female patients.This article summarizes the authors' experience in the diagnosis and treatment of lactational infection after breast augmentation by PAHG injection and discusses related preventive measures.Methods: This study included 2 patients who had developed infection during lactation 5 years after breast augmentation with PAHG.We identified the exact position of the PAHG and vomica by color Doppler,computerized tomography and magnetic resonance.We made incisions in the submammary fold or mammary areola to take out the PAHG,drain the pus and place the vacuum pressure tube,followed by application of pressure bandages.Results: One of the patients healed without any complication,while the other developed latex leak in both breasts,but finally cured after milk regurgitation and repeated changing of dressings.Conclusion: Lactational infection after breast augmentation by PAHG injection is detrimental to female patients.Preventive measures should be taken as early as possible.For patients with this infection,operation should be performed to take out the PAHG and drain the pus.Sufficient draining and milk regurgitation are necessary to avoid latex leak.
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Objective:To observe and compare the wound healing effects,the time and costs of hospitalization of the two drainage ways in the breast polyacrylamide hydrogel removing operations by a prospective randomized controlled approach.Methods:From December 2004 to December 2009,a total of 54 breast-side of 40 patients,whose incision were not healing after breast polyacrylamide hydrogel removing operations,were divided into two groups.Both gorups'skin incision were on the areola or inframammary crease.In the case of removing the polyacrylamide hydrogel during the operation as much as possible,a new incision,approximately 1.5cm,was produced below the inframammary crease approximately 5cm,the negative drainage tube was inserted into the new incision in the A group(distal drainage way),While the negative drainage tube was inserted into the original incision in B group(In-situ drainage way).Results:The breast appearance was flat and thin,the texture was soft and there was no mass or sclerosis.There were significant differences between the two methods in primary healing,the time and costs of hospitalization.Conclusion:The clinical effect of the distal drainage way is better than the clinical effect of the In-situ drainage way,and it deserves to apply in clinical practice.
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Objective To investigate complications of polyacrylamide hydrogel injection for augmentation mammaplasty and treatment of the complications so as to reduce the suffering of the patients to the lowest degree. Methods The clinical signs of 8 cases who had complications after polyacrylamide hydrogel injection for augmentation mammaplasty were studied. Results The complications of 8 cases included bleeding, hard nodule, aseptic inflammation and difficulty to clean the filling material completely from the normal tissue of human body. Conclusions The complications mainly result from improper procedure during the operation. Cautious attitude should be taken in the clinical application of this material and it should not be abused. Furthermore, the standard and appropriate method and technique for the operation should be employed.
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Objective:To search for a safe,effective and convenient treatment for the complications after polyacrylamide hydrogel(PAHG)injection for augmentation mammaplasty.Methods:47 patients with complications after PAHG injection for augmentation mammaplasty were included.B type ultrasound detection was performed Preoperatively in order to find out the distribution of PAHG.After local anesthesia,a 10 mm incision was made at submammary fold of each patients.Under the guidance of endoscope,PAHG was rinsed by tumescent technique at low pressure and aspirated out for several times,until the capsule wall of PAHG was clean and the rinse solution was clear.The infiltrative tissue was excised.Negative pressure drainage tube and antibiotics were used postoperatively and the patients were followed for 5～20 weeks.Results:All incisions were primarily healed,leaving no hematoma or infection.All patients were satisfied with disappearance of pain in the breasts,soft mammary tissue without any noeud and no PAHG remains which was detected by B type ultrasound.Conclusion:Minimally Invasive endoscopic treatment for complications of PAHG injection for augmentation mammaplasty was characterized by its micro-incision,accurate operation,high PAHG clearance,minimal trauma of tissue and reliable hemostasis,worth to be widely used.
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Objective:To study the change of immunological response and cell proliferation in breast tissues augmented by polyacrylamide hydrogel injection(PHI).Methods:The expression of CD68,CD25 and PCNA in 20 breast tissues with indurations,12 without indurations after breast augmentation by PHI,and 10 normal breast tissues was examined by immunohistochemistry P-V6000; analysis was also done by H-E staining.Results:Hyperplasia of fibrous tissue and infiltration of inflammatory cells and macrophages were found in the breast and adjacent tissues 3-8 years after PHI.Positive cells of CD68,CD25 and PCNA hardly existed in the normal tissues,but the breast tissues around the polyacrylamide hydrogel had many positive cells of CD68 and PCNA,especially in cases with indurations;there were significant differences between the 3 groups(P