Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3322-3328
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3322
Repeated lumps and infections: A case report on breast augmentation complications
Ming-Xuan Zhang, Shi-Yan Li, Li-Long Xu, Bo-Wen Zhao, Xiao-Yan Cai, Guang-Lan Wang
Ming-Xuan Zhang, Shi-Yan Li, Li-Long Xu, Bo-Wen Zhao, Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
Xiao-Yan Cai, General Surgical Department, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
Guang-Lan Wang, Pathology Department, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
Author contributions: Zhang MX reviewed the literature and contributed to manuscript drafting; Xu LL and Zhao BW were responsible for the revision of the manuscript for important intellectual content; Li SY was the patient’s sonographer and reviewed the literature; Cai XY was the patient’s surgeon and contributed to the manuscript drafting; Wang GL presented the patient’s pathology picture and interpreted the imaging findings. All authors issued final approval for the version to be submitted.
Supported by Zhejiang Provincial Medical and Health Platform Project, No. 2018275889.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Long Xu, MD, Attending Doctor, Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, No. 3, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. 3406047@zju.edu.cn
Telephone: +86-0571-86006331 Fax: +86-0571-86006331
Received: May 5, 2019
Peer-review started: May 5, 2019
First decision: September 9, 2019
Revised: September 22, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: October 26, 2019
Abstract
BACKGROUND

Polyacrylamide hydrogel (PAAG) injections were once common in breast augmentation and have been prohibited for augmentation mammaplasty in China since a large number of patients who underwent breast augmentation with PAAG injections have continued to seek medical advice as a result of related complications. Among all these complications, distant migration is relatively rare.

CASE SUMMARY

A 49-year-old female presented at the hospital with a one-year history of a vulvar lump. The sonography of the lump showed several subcutaneous fluid-filled regions from the left vulva to the pubic symphysis, which suggested possible fat liquefaction. An enhanced magnetic resonance imaging (MRI) revealed a cystic area, which was considered a benign lesion. Intraoperative observations showed that the mass did not have an obvious capsule, the subcutaneous tissue presented as a cavity, and some yellow material came out of this cavity. A culture of the drainage did not show bacterial contamination. Histopathology revealed a foreign body granuloma. After resection and closed drainage, lumps were successively observed in the left lower abdomen and the bilateral hypochondriac region with infections. Sonography found that the hypoechoic areas in the bilateral hypochondriac region seemed continuous with deep in the breasts. The patient reported that she had undergone surgery with PAAG injections 20 years ago after she was repeatedly asked about her past history. Finally, a diagnosis of distant migration of PAAG was made.

CONCLUSION

PAAG gel can migrate after long periods of time. A diagnosis should not be limited to the area where the symptom develops.

Keywords: Breast augmentation, Distant migration, Repeated lump, Repeated infection, Case report

Core tip: Among the complications of PAAG injections, distant migration is relatively rare. Symptoms at presentation depend on the course and sometimes may be misdiagnosed. Here, we present a rare case of a patient who repeatedly presented with lumps and infections, without bacterial contamination or an obvious histopathologic explanation. This case shows that PAAG gel can migrate after long periods of time, and debridement surgery may be necessary even without symptoms. It took four months to make an accurate diagnosis since the patient did not disclose her history, which serves as a reminder not to limit our diagnostic ideas to the symptomatic area.