Is hyaluronic acid gel a good option for breast augmentation?

Complications after breast augmentation with hyaluronic acid: a case report

Breast augmentation is a very requested procedure in aesthetic surgery. Over time, various techniques of breast augmentation have been described, both through the use of alloplastic materials and autologous tissues: implants, fat grafting, flap surgery, and injectable fillers. According to the international current trend to perform minimally invasive procedure, injectable fillers have progressively increased their uses and notoriety in aesthetic medicine. Among the various available products, hyaluronic acid is likely to be the most popular synthetic filler all over the world. Nowadays many brands are on the market and this paper focuses on Macrolane which is a NASHA-based (stabilized hyaluronic acid of non-animal origin) filler. However, although highly biocompatible, as any material, foreign to our body, also hyaluronic acid fillers undergo a process of degradation and disposal. In our work, we report the first case in literature of migration of Macrolane in an axillary lymph node in a 45-year-old woman three years after injection for breast augmentation and its related management. The aim of the paper is to discuss and underline further complications and their treatment besides the ones already described in literature in order to provide a deeper knowledge concerning the use and the side effects of injectable fillers in aesthetic medicine.

[Cosmetic Breast Augmentation without Silicone Implants]

Cosmetic Breast Augmentation without Silicone Implants Abstract. Cosmetic breast augmentation procedures without silicone implants are becoming increasingly popular. Mastopexy can be adapted to the needs of the patient and usually result in an at least optical augmentation. Lipofilling is a safe procedure in reconstructive and aesthetic breast surgery and can help to restore natural appearance, compensate volume deficiencies, and correct asymmetries, that may be congenital or a consequence of prior surgeries. Cosmetic breast augmentation of very small breasts or when aiming at higher breast volumes using lipofilling only are usually combined with procedures for tissue expansion in order to increase the take rate of the injected fat. Hyaluronic acid injections is no valid alternative and are not recommended for cosmetic breast augmentation.

A case series study on complications after breast augmentation with Macrolane™

BACKGROUND

The use of Macrolane™ seems to have several advantages compared to the other standard methods for breast augmentation: it is faster, less invasive, and requires only local anesthesia. Nevertheless, various complications associated with the use of Macrolane™ have been described, e.g., encapsulated lumps in breast tissue, infection, and parenchymal fibrosis. We report the results of our case series study on the clinical and imaging evaluations of patients who came to our attention after breast augmentation with Macrolane™ injection and evaluate the effect of this treatment on breast cancer screening procedures.

METHODS

Between September 2009 and July 2010, seven patients, treated elsewhere with intramammary Macrolane™ injection for cosmetic purposes, presented to our institution complaining of breast pain. In all patients, Macrolane™ had been injected under local anesthesia in the retromammary space through a surgical cannula.

RESULTS

On mammography, nodules appeared as gross lobulated radiopacities with polycyclic contours. On breast ultrasound, the nodules showed hypo-anaechogenic cystlike features. In all cases, image analysis by the radiologist was hindered by the presence of the implanted substance, which did not allow the complete inspection of the whole breast tissue.

CONCLUSIONS

From our experience, although safe in other areas, injection of Macrolane™ into breast tissue cannot be recommended at this time. Our study, along with other reports, supports the need to start a clinical trial on the use of injectable fillers in the breast to validate their safety and effectiveness.

LEVEL OF EVIDENCE IV

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 .

Aesthetic breast augmentation with hyaluronic acid: imaging findings and implications for radiological assessment

New injectable fillers such as hyaluronic acid have recently been employed as a non-surgical alternative to implants such as silicone for aesthetic breast enhancement. Although their utilization is not yet widespread in Brazil, radiologists should be aware of the imaging findings in this context and of the implications of the presence of this filler for the radiological evaluation in the screening for breast cancer.