Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 ZhiZao Ju Road, Shanghai, 200011, People's Republic of China.
Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Aesthetic Plast Surg. 2022 Oct;46(5):2107-2121. doi: 10.1007/s00266-022-02876-w. Epub 2022 Apr 20.
Polyacrylamide hydrogel (PAAG) has been used globally for breast augmentation, leading to long-term clinical complications. However, whether the infiltrated fibrotic capsule should be removed with PAAG to alleviate the complications remains unclear. This study aimed to ascertain different causes of complications and proper management strategies for PAAG removal in augmented breasts.
From July 2015 to December 2019, patients who underwent breast augmentation with PAAG and in whom surgical intervention was undertaken for PAAG-associated adverse events at Shanghai Ninth People's Hospital were retrospectively reviewed. Patients were categorized into two groups according to whether the fibrotic capsule was removed (RFC) or not (NRFC). Aesthetic outcomes, PAAG residues, and adverse events were evaluated post-operatively to assess whether important issues pertaining to these arose following fibrotic capsule removal. Tissue histology and PAAG degradation analysis were implemented to investigate immune response, degradability, and toxicity of PAAG.
Altogether, 257 patients (88 RFC and 169 NRFC patients) were enrolled. 73.4% and 79.5% of the RFC and NRFC groups showed fairly good outcomes, with no significant difference, respectively. (X= 0.0804, p = 0.79) Significant differences were found between two surgical techniques upon patient satisfaction, respectively. (X= 3.529; p = 0.0301). Predictor of poor outcomes identified scar (OR, 4.555, p = 0.0019) and PAAG residue (OR, 5.379, p = 0.0003). Predictor of patient satisfaction identified post-operative outcomes (OR, 3.797; 95% CI, 1.860-8.923; p = 0.0002) and surgical technique (NRFC) (OR, 2.519; 95% CI, 1.449-4.434; p = 0.0008).
Both treatment strategies showed good results in our study. Removal of the fibrotic capsule from infiltration of PAAG largely depends on the individual psychological condition, aesthetic expectations, complications, and magnetic resonance imaging results. While PAAG does not degrade in the host's body over time, it may elicit immune reactions and chronic inflammation in the long term.
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聚酰胺水凝胶（PAAG）已在全球范围内用于隆胸，导致长期的临床并发症。然而，是否应该去除与 PAAG 一起浸润的纤维囊以减轻并发症尚不清楚。本研究旨在确定隆胸中 PAAG 去除的不同并发症原因和适当的管理策略。
2015 年 7 月至 2019 年 12 月，回顾在上海第九人民医院因 PAAG 相关不良事件接受隆胸并接受 PAAG 相关不良事件手术干预的患者。根据是否去除纤维囊（RFC）将患者分为两组。评估术后美容效果、PAAG 残留和不良事件，以评估去除纤维囊后是否出现与这些相关的重要问题。实施组织学和 PAAG 降解分析，以研究 PAAG 的免疫反应、降解性和毒性。
共纳入 257 例患者（88 例 RFC 和 169 例 NRFC 患者）。RFC 和 NRFC 组分别有 73.4%和 79.5%的患者表现出相当好的结果，无显著差异（X=0.0804，p=0.79）。两组手术技术的患者满意度存在显著差异（X=3.529；p=0.0301）。不良结局的预测因素为瘢痕（OR，4.555，p=0.0019）和 PAAG 残留（OR，5.379，p=0.0003）。患者满意度的预测因素为术后结局（OR，3.797；95%CI，1.860-8.923；p=0.0002）和手术技术（NRFC）（OR，2.519；95%CI，1.449-4.434；p=0.0008）。
在本研究中，两种治疗策略均显示出良好的效果。从 PAAG 浸润中去除纤维囊在很大程度上取决于个体的心理状况、审美期望、并发症和磁共振成像结果。虽然 PAAG 不会随着时间的推移在体内降解，但它可能会在长期内引发免疫反应和慢性炎症。
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