Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
World J Surg. 2012 Apr;36(4):695-701. doi: 10.1007/s00268-011-1273-6.
Polyacrylamide gel (PAAG) was first manufactured in Ukraine in the late 1980s and introduced as a biomaterial for "breast augmentation without surgery." Since it is prohibited in most countries, PAAG injections are rare nowadays, but their consequences and long-term complications can be crucial.
We identified 106 patients consecutively operated on for PAAG complications at three teaching Ukrainian hospitals between 1998 and 2009. All relevant sociodemographic, clinical, and treatment characteristics were collected. Forty-five (42%) patients were available for clinical follow-up.
The majority (88%) had had bilateral PAAG injections. The mean volume of injected PAAG was 230 ml/breast (range = 50-400). Mean age at injection was 29 years (range = 17-49) and the mean time from the injection to complications was 6.1 years (SD = 4.1). Symptoms preceding debridement were pain in 85 patients (80%), breast hardening in 79 (74%), breast deformity in 77 (73%), lumps in 57 (54%), gel migration in 39 (37%), fistulas in 17 (16%), and gel leakage in 12 (11%). The surgical interventions in 199 breasts included gel evacuation alone in 107 (54%) or in combination with partial mastectomy in 65 (33%), partial mastectomy and partial pectoralis muscle resection in 12 (6%), or subcutaneous mastectomy in 15 (7%). Of the 199 operated breasts, 86 (43%) immediate and 58 (29%) delayed implant-based breast reconstructions were performed.
Injections of PAAG can cause irreversible damage to the breast necessitating complex debridement procedures, even mastectomy and breast reconstruction. Despite numerous surgical interventions, gel remnants are still found on subsequent breast imaging. Although PAAG is prohibited in many countries, different types of injections with unknown long-term effects are currently being used. Making the public aware of the problems of injectables for breast augmentation is warranted.
聚丙烯酰胺凝胶（PAAG）于 20 世纪 80 年代末在乌克兰首次制造，并作为“无需手术的隆胸”生物材料引入。由于它在大多数国家被禁止，目前 PAAG 注射很少见，但它们的后果和长期并发症可能是至关重要的。
我们在 1998 年至 2009 年间在三家乌克兰教学医院连续对 106 例 PAAG 并发症患者进行了手术，并收集了所有相关的社会人口统计学、临床和治疗特征。45 名（42%）患者可进行临床随访。
大多数（88%）患者接受了双侧 PAAG 注射。注射的 PAAG 平均体积为 230ml/乳房（范围=50-400）。注射时的平均年龄为 29 岁（范围=17-49），从注射到并发症的平均时间为 6.1 年（SD=4.1）。在清创前出现的症状有 85 例（80%）患者疼痛，79 例（74%）患者乳房变硬，77 例（73%）患者乳房变形，57 例（54%）患者有肿块，39 例（37%）患者有凝胶迁移，17 例（16%）患者有瘘管，12 例（11%）患者有凝胶渗漏。199 例乳房手术干预包括单纯凝胶抽吸 107 例（54%）或联合部分乳房切除术 65 例（33%），部分乳房切除术和部分胸大肌切除术 12 例（6%），或皮下乳房切除术 15 例（7%）。在 199 例接受手术的乳房中，立即进行 86 例（43%）植入物乳房重建，58 例（29%）延迟进行。
PAAG 注射会对乳房造成不可逆转的损害，需要进行复杂的清创手术，甚至乳房切除术和乳房重建。尽管进行了多次手术干预，但在随后的乳房成像中仍发现凝胶残留物。尽管 PAAG 在许多国家被禁止，但目前正在使用不同类型的注射剂，其长期效果尚不清楚。有必要让公众了解注射隆胸的问题。
