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Cosmetic Augmentation Injections
Wendie A. Berg, MD, PhD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Injection of liquid oil, wax, gel, or fat into breast parenchyma for cosmetic augmentation: Interstitial mammoplasty
              • Any type of cosmetic injection may result in foreign body ± granulomatous reaction
              • Paraffinoma = oleogranulomatous mastitis: Reactive fibrotic mass surrounding area(s) of injected paraffin
              • Siliconoma: Reactive fibrotic mass (silicone mastitis) surrounding area(s) of injected silicone oil or silicone gel from implant rupture
              • Polyacrylamide hydrogel (PAAG) injections: Round liquid deposits that mimic extracellular matrix
              • Fat injections = autologous fat transfer = fat grafting = lipoaugmentation: Liposuction harvesting of fat from elsewhere in body, washing cells/purification, and reinjecting fat cells into breast
            • Aquafilling gel: Soft tissue filler used for lips and face now being tried for breast; prone to infection, necrosis

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Economides JM et al: Latissimus dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction. Plast Reconstr Surg Glob Open. 6(1):e1656, 2018
                                          2. Jung BK et al: Complication of AQUAfilling® gel injection for breast augmentation: case report of one case and review of literature. Aesthetic Plast Surg. 42(5):1252-6, 2018
                                          3. Mess SA: Lipoaugmentation following implant removal preferred by plastic surgeons and the general public. Plast Reconstr Surg Glob Open. 6(8):e1882, 2018
                                          4. Ryu AJ et al: Spectrum of chronic complications related to silicone leakage and migration. Am J Med. 131(11):1383-6, 2018
                                          5. Kontoes P et al: Complications of fat transfer for breast augmentation. Aesthetic Plast Surg. 41(5):1078-82, 2017
                                          6. Shida M et al: Ultrasound diagnosis and treatment of breast lumps after breast augmentation with autologous fat grafting. Plast Reconstr Surg Glob Open. 5(12):e1603, 2017
                                          7. Son MJ et al: Complications and radiologic features of breast augmentation via injection of Aquafilling Gel. J Ultrasound Med. 37(7):1835-9, 2018
                                          8. Al Sufyani MA et al: Autologous fat transfer for breast augmentation: a review. Dermatol Surg. 42(11):1235-42, 2016
                                          9. Chen B et al: Management of breast deformity after removal of injectable polyacrylamide hydrogel: retrospective study of 200 cases for 7 years. Aesthetic Plast Surg. 40(4):482-91, 2016
                                          10. Becchere MP et al: A case series study on complications after breast augmentation with Macrolane™. Aesthetic Plast Surg. 37(2):332-5, 2013
                                          11. Costantini M et al: Radiological findings in mammary autologous fat injections: a multi-technique evaluation. Clin Radiol. 68(1):27-33, 2013
                                          12. Patlazhan G et al: Breast reconstruction and treatment algorithm for patients with complications after polyacrylamide gel injections: a 10-year experience. Aesthetic Plast Surg. 37(2):312-20, 2013
                                          13. Rubin JP et al: Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg. 129(5):1029-38, 2012
                                          14. Sánchez-Ponte A et al: Illegal injection of industrial silicone oil for breast augmentation: risks, solutions and results. Breast J. 18(2):174-6, 2012
                                          15. Unukovych D et al: Polyacrylamide gel injections for breast augmentation: management of complications in 106 patients, a multicenter study. World J Surg. 36(4):695-701, 2012
                                          16. Vanwambeke K et al: Breast augmentation by injection of free silicone: MRI findings. JBR-BTR. 95(1):34, 2012
                                          17. Khedher NB et al: Imaging findings of breast augmentation with injected hydrophilic polyacrylamide gel: patient reports and literature review. Eur J Radiol. 78(1):104-11, 2011
                                          18. Luo SK et al: Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients. J Plast Reconstr Aesthet Surg. 64(6):731-7, 2011
                                          19. Veber M et al: Radiographic findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg. 127(3):1289-99, 2011
                                          20. Yang N et al: The augmented breast: a pictorial review of the abnormal and unusual. AJR Am J Roentgenol. 196:W451-W460, 2011
                                          21. Ho L et al: FDG PET/CT imaging in granulomatous changes secondary to breast silicone injection. Clin Radiol. 65(8):659-61, 2010
                                          22. Kang BJ et al: The clinical and imaging characteristics of breast cancers in patients with interstitial mammoplasty. Arch Gynecol Obstet. 281(6):1029-35, 2010
                                          23. Peters W et al: Complications from injectable materials used for breast augmentation. Can J Plast Surg. 17(3):89-96, 2009
                                          24. Youk JH et al: Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection. Clin Radiol. 64(12):1175-80, 2009
                                          25. Carvajal J et al: Mammographic findings after breast augmentation with autologous fat injection. Aesthet Surg J. 28(2):153-62, 2008
                                          26. Lui CY et al: Evaluation of MRI findings after polyacrylamide gel injection for breast augmentation. AJR Am J Roentgenol. 191(3):677-88, 2008
                                          27. Teo SY et al: Radiologic features of polyacrylamide gel mammoplasty. AJR Am J Roentgenol. 191(3):W89-95, 2008
                                          28. Erguvan-Dogan B et al: Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications. AJR Am J Roentgenol. 186(3):888-94, 2006
                                          29. Scaranelo AM et al: Sonographic and mammographic findings of breast liquid silicone injection. J Clin Ultrasound. 34(6):273-7, 2006
                                          30. Qiao Q et al: Management for postoperative complications of breast augmentation by injected polyacrylamide hydrogel. Aesthetic Plast Surg. 29(3):156-61; discussion 162, 2005
                                          31. Christensen LH et al: Long-term effects of polyacrylamide hydrogel on human breast tissue. Plast Reconstr Surg. 111(6):1883-90, 2003
                                          32. Cheung YC et al: Lumpy silicone-injected breasts: enhanced MRI and microscopic correlation. Clin Imaging. 26(6):397-404, 2002
                                          33. Wang J et al: Silicone migration from silicone-injected breasts: magnetic resonance images. Ann Plast Surg. 48(6):617-21, 2002
                                          34. Han BK et al: Foreign body granulomas of the breast presenting as bilateral spiculated masses. Korean J Radiol. 2(2):113-6, 2001
                                          35. Khong PL et al: MR imaging of breast paraffinomas. AJR Am J Roentgenol. 173(4):929-32, 1999
                                          36. Lopez H et al: Ultrasound interactions with free silicone in a tissue-mimicking phantom. J Ultrasound Med. 17(3):163-70, 1998
                                          37. Helbich TH et al: The value of MRI in silicone granuloma of the breast. Eur J Radiol. 24(2):155-8, 1997
                                          38. Yang WT et al: Paraffinomas of the breast: mammographic, ultrasonographic and radiographic appearances with clinical and histopathological correlation. Clin Radiol. 51(2):130-3, 1996
                                          39. Ko C et al: Injected liquid silicone, chronic mastitis, and undetected breast cancer. Ann Plast Surg. 34(2):176-9, 1995
                                          40. Leibman AJ et al: Mammographic and sonographic findings after silicone injection. Ann Plast Surg. 33(4):412-4, 1994
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Injection of liquid oil, wax, gel, or fat into breast parenchyma for cosmetic augmentation: Interstitial mammoplasty
                                                      • Any type of cosmetic injection may result in foreign body ± granulomatous reaction
                                                      • Paraffinoma = oleogranulomatous mastitis: Reactive fibrotic mass surrounding area(s) of injected paraffin
                                                      • Siliconoma: Reactive fibrotic mass (silicone mastitis) surrounding area(s) of injected silicone oil or silicone gel from implant rupture
                                                      • Polyacrylamide hydrogel (PAAG) injections: Round liquid deposits that mimic extracellular matrix
                                                      • Fat injections = autologous fat transfer = fat grafting = lipoaugmentation: Liposuction harvesting of fat from elsewhere in body, washing cells/purification, and reinjecting fat cells into breast
                                                    • Aquafilling gel: Soft tissue filler used for lips and face now being tried for breast; prone to infection, necrosis

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Economides JM et al: Latissimus dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction. Plast Reconstr Surg Glob Open. 6(1):e1656, 2018
                                                                                  2. Jung BK et al: Complication of AQUAfilling® gel injection for breast augmentation: case report of one case and review of literature. Aesthetic Plast Surg. 42(5):1252-6, 2018
                                                                                  3. Mess SA: Lipoaugmentation following implant removal preferred by plastic surgeons and the general public. Plast Reconstr Surg Glob Open. 6(8):e1882, 2018
                                                                                  4. Ryu AJ et al: Spectrum of chronic complications related to silicone leakage and migration. Am J Med. 131(11):1383-6, 2018
                                                                                  5. Kontoes P et al: Complications of fat transfer for breast augmentation. Aesthetic Plast Surg. 41(5):1078-82, 2017
                                                                                  6. Shida M et al: Ultrasound diagnosis and treatment of breast lumps after breast augmentation with autologous fat grafting. Plast Reconstr Surg Glob Open. 5(12):e1603, 2017
                                                                                  7. Son MJ et al: Complications and radiologic features of breast augmentation via injection of Aquafilling Gel. J Ultrasound Med. 37(7):1835-9, 2018
                                                                                  8. Al Sufyani MA et al: Autologous fat transfer for breast augmentation: a review. Dermatol Surg. 42(11):1235-42, 2016
                                                                                  9. Chen B et al: Management of breast deformity after removal of injectable polyacrylamide hydrogel: retrospective study of 200 cases for 7 years. Aesthetic Plast Surg. 40(4):482-91, 2016
                                                                                  10. Becchere MP et al: A case series study on complications after breast augmentation with Macrolane™. Aesthetic Plast Surg. 37(2):332-5, 2013
                                                                                  11. Costantini M et al: Radiological findings in mammary autologous fat injections: a multi-technique evaluation. Clin Radiol. 68(1):27-33, 2013
                                                                                  12. Patlazhan G et al: Breast reconstruction and treatment algorithm for patients with complications after polyacrylamide gel injections: a 10-year experience. Aesthetic Plast Surg. 37(2):312-20, 2013
                                                                                  13. Rubin JP et al: Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg. 129(5):1029-38, 2012
                                                                                  14. Sánchez-Ponte A et al: Illegal injection of industrial silicone oil for breast augmentation: risks, solutions and results. Breast J. 18(2):174-6, 2012
                                                                                  15. Unukovych D et al: Polyacrylamide gel injections for breast augmentation: management of complications in 106 patients, a multicenter study. World J Surg. 36(4):695-701, 2012
                                                                                  16. Vanwambeke K et al: Breast augmentation by injection of free silicone: MRI findings. JBR-BTR. 95(1):34, 2012
                                                                                  17. Khedher NB et al: Imaging findings of breast augmentation with injected hydrophilic polyacrylamide gel: patient reports and literature review. Eur J Radiol. 78(1):104-11, 2011
                                                                                  18. Luo SK et al: Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients. J Plast Reconstr Aesthet Surg. 64(6):731-7, 2011
                                                                                  19. Veber M et al: Radiographic findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg. 127(3):1289-99, 2011
                                                                                  20. Yang N et al: The augmented breast: a pictorial review of the abnormal and unusual. AJR Am J Roentgenol. 196:W451-W460, 2011
                                                                                  21. Ho L et al: FDG PET/CT imaging in granulomatous changes secondary to breast silicone injection. Clin Radiol. 65(8):659-61, 2010
                                                                                  22. Kang BJ et al: The clinical and imaging characteristics of breast cancers in patients with interstitial mammoplasty. Arch Gynecol Obstet. 281(6):1029-35, 2010
                                                                                  23. Peters W et al: Complications from injectable materials used for breast augmentation. Can J Plast Surg. 17(3):89-96, 2009
                                                                                  24. Youk JH et al: Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection. Clin Radiol. 64(12):1175-80, 2009
                                                                                  25. Carvajal J et al: Mammographic findings after breast augmentation with autologous fat injection. Aesthet Surg J. 28(2):153-62, 2008
                                                                                  26. Lui CY et al: Evaluation of MRI findings after polyacrylamide gel injection for breast augmentation. AJR Am J Roentgenol. 191(3):677-88, 2008
                                                                                  27. Teo SY et al: Radiologic features of polyacrylamide gel mammoplasty. AJR Am J Roentgenol. 191(3):W89-95, 2008
                                                                                  28. Erguvan-Dogan B et al: Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications. AJR Am J Roentgenol. 186(3):888-94, 2006
                                                                                  29. Scaranelo AM et al: Sonographic and mammographic findings of breast liquid silicone injection. J Clin Ultrasound. 34(6):273-7, 2006
                                                                                  30. Qiao Q et al: Management for postoperative complications of breast augmentation by injected polyacrylamide hydrogel. Aesthetic Plast Surg. 29(3):156-61; discussion 162, 2005
                                                                                  31. Christensen LH et al: Long-term effects of polyacrylamide hydrogel on human breast tissue. Plast Reconstr Surg. 111(6):1883-90, 2003
                                                                                  32. Cheung YC et al: Lumpy silicone-injected breasts: enhanced MRI and microscopic correlation. Clin Imaging. 26(6):397-404, 2002
                                                                                  33. Wang J et al: Silicone migration from silicone-injected breasts: magnetic resonance images. Ann Plast Surg. 48(6):617-21, 2002
                                                                                  34. Han BK et al: Foreign body granulomas of the breast presenting as bilateral spiculated masses. Korean J Radiol. 2(2):113-6, 2001
                                                                                  35. Khong PL et al: MR imaging of breast paraffinomas. AJR Am J Roentgenol. 173(4):929-32, 1999
                                                                                  36. Lopez H et al: Ultrasound interactions with free silicone in a tissue-mimicking phantom. J Ultrasound Med. 17(3):163-70, 1998
                                                                                  37. Helbich TH et al: The value of MRI in silicone granuloma of the breast. Eur J Radiol. 24(2):155-8, 1997
                                                                                  38. Yang WT et al: Paraffinomas of the breast: mammographic, ultrasonographic and radiographic appearances with clinical and histopathological correlation. Clin Radiol. 51(2):130-3, 1996
                                                                                  39. Ko C et al: Injected liquid silicone, chronic mastitis, and undetected breast cancer. Ann Plast Surg. 34(2):176-9, 1995
                                                                                  40. Leibman AJ et al: Mammographic and sonographic findings after silicone injection. Ann Plast Surg. 33(4):412-4, 1994