Breast reconstruction and treatment algorithm for patients with complications after polyacrylamide gel injections: a 10-year experience.

An algorithm for breast reconstruction for patients with complications after polyacrylamide gel (PAAG) injections is presented, and the outcomes of surgery using the adopted treatment protocol are evaluated. We reviewed the clinical records of consecutive patients who were treated for PAAG complications with breast reconstruction at two surgical centers between 2000 and 2010 (n=154). All patients had one or more complications from PAAG injections and underwent gel removal and breast reconstruction with implants. One hundred women who underwent conventional breast augmentation with implants matching the study cohort comprised a reference group. Of the total of 154 patients, 121 (79%) women had no signs of acute inflammation and underwent a single-stage surgery comprising gel removal and immediate breast reconstruction (group I). The remaining 33 (21%) patients had signs of acute inflammation (group II) and underwent two-stage surgery with delayed reconstruction. Subgroup analysis of group I revealed that submuscular implant placement was associated with a lower probability of capsular contracture (CC) than was subglandular placement (17 vs. 36%, p<0.05). The rate of CC in patients with textured implants (n=81) was 24.8%, whereas no CC was registered among patients with micropolyurethane surface implants (n=40). The rate of early surgical complications in group I, group II, and the reference group was 39, 51.5, and 9%, respectively. The probability of reoperation after breast reconstruction in group I and in group II was 34 and 42%, respectively. Complications and subsequent breast reconstruction in patients after PAAG injection pose a challenge to the surgeon; however, satisfactory results can be achieved in the majority of patients. The reconstruction algorithm described here may serve as a useful tool for breast surgeons dealing with PAAG complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .