Late complications after application of polyacrylamide hydrogel

Since 1994, a new filling material (polyacrylamide 5% hydrogel, composed of acrylamide, methylenbisacrylamide, tetramethylendiamine and distilled water) has been used by several surgeons in Bulgaria. The indications for the use of hydrogel as recommended by the manufacturer are as follows: treatment of depressions and wrinkles of the glabella, malar and upper lip region, lip augmentation, augmentation mammaplasty, phalloplasty, atrophy or paralysis of the vocal cords, Romberg syndrome and many other similar conditions. Despite good immediate results, numerous long-term complications have been observed. The hydrogel diffuses into areas with minimal resistance and moves downward with time. The most serious problems arise after injection of hydrogel to augment breasts. The injected hydrogel disseminates in all directions into tissues of the gland and the muscles; this has been confirmed histologically. Early diagnosis of mammary tumors is made impossible in such women because it is very difficult to differentiate between the injected hydrogel and a possible neoplastic process. Other complications which have been encountered are necrosis of the skin and tissues of the breast and migration of the hydrogel causing functional disruption of the penis and eyes, etc. The hydrogel changes its position and diffuses throughout the tissues. Removal of the injected hydrogel is extremely difficult and frequently may not be possible. In conclusion, the use of this type of material is dangerous; it requires further research, and it is recommended that its use be discontinued at this moment.