Surgical Management of Distant Migration Complications Post-PAAG Breast Augmentation--Case Report and Literature Review

聚丙烯醯胺凝膠隆乳遠距離移位併發症之手術處理──個案報告與文獻回顧

Tzu-Yi Chung(鍾子毅) ； Kwang-Yi Tung(董光義) ； Wen-Chen Huang(黃文成) ； Chia-Meng Yu(游家孟) ； Ming-Feng Tsai(蔡明峰) ； Wen-Teng Yao(姚文騰) ； Chieh-Ming Yu(尤傑銘) ； Hung-Wei Liao(廖紘緯)

《臺灣整形外科醫學會雜誌》 33卷4期 (2024/12) Pp. 401-411

摘要

Background: Polyacrylamide Hydrogel (PAAG) was once a widely used soft tissue filler in cosmetic surgery, and the brand "Amazingel" was used extensively. However, as clinical practice advanced, concerns about its safety have grown. Notably, the potential for long-distance migration of PAAG poses a serious risk, leading to severe complications including tissue reactions and infections. Aim and Objectives: This report aims to explore the complications resulting from the distant migration of PAAG and to discuss the strategies for its surgical management. Materials and Methods: Twenty years after undergoing PAAG breast augmentation, the patient presented with bilateral thigh swelling and signs of infection, with no prior complications reported since the procedure. Incision and drainage (I&D) surgery revealed extensive PAAG migration to the bilateral thighs. Advanced imaging techniques, including intraoperative ultrasound and CT scans, were employed to detail the widespread migration of PAAG to both sides of the waist, lower abdomen, inguinal, pubic area, and thighs. The patient underwent a combination of endoscopic and open surgical interventions to effectively remove the extensively migrated filler. Results: The patient required multiple surgical interventions due to the extensive range of migrated material. These interventions included a combination of endoscopic and open surgical techniques to remove PAAG and necrotic tissue as cleanly as possible. No recurrence was observed during the six-month post-surgery follow-up. Conclusion: This case highlights the complexity and potential dangers of PAAG migration and underscores the importance of a comprehensive approach to surgical management. Combining ultrasound, endoscopic assistance, and open surgical procedures, the multimodal surgical strategy implemented offers a viable option for effectively handling complex cases of this nature.

關鍵字

polyacrylamide hydrogel (PAAG) ； breast augmentation ； complication ； injection mammaplasty

並列摘要

背景：聚丙烯醯胺凝膠（PAAG）過去作為軟組織填充物在美容外科手術中被廣泛使用，尤其是以「Amazingel」品牌在中國廣為人知。然而，隨著臨床經驗的累積，對其安全性的擔憂逐漸增加。特別是，PAAG的遠距離移位可能性引起了廣泛關注，這一現象可能導致嚴重的組織反應和感染等併發症。本病例報告透過探討一名43歲女性患者隆乳後PAAG遠距離移位至雙側大腿的病例，深入分析了PAAG移位的治療挑戰與複雜性。目的及目標：旨在探討PAAG隆乳術後遠距離移位，所引起的併發症及其手術治療策略。材料及方法：該患者在接受PAAG隆乳術二十年後，因雙側大腿腫脹及感染症狀求診，過去除乳房逐漸變小未報告過任何併發症。切開與引流手術揭示了PAAG在雙側大腿內側的廣泛遷移。應用影像技術，包括術前電腦斷層掃描和術中超音波，詳細定位了PAAG向雙側腰部、下腹部、腹股溝、恥骨區及大腿的廣泛遷移。患者接受了內視鏡輔助與開放式清創手術的結合介入治療，有效地移除了大量遷移的填充物。結果：患者因遷移物質範圍廣泛而接受了多次手術干預。通過內視鏡輔助手術與開放式清創手術的結合移除較深部位的病變。患者在術後一個月和六個月的隨訪中未發現復發。結論：本案例強調了PAAG移位的複雜性和潛在風險，並凸顯了詳細病史詢問的重要性。治療上，採用術中超音波診斷、內視鏡輔助手術及開放式手術的結合治療策略，對於處理此類複雜病例顯示出有效性。這種多模式手術治療策略為相似病例提供了重要的治療選擇，有助於醫生面對此類挑戰時做出更全面和精確的治療決策。