DOI:10.2214/AJR.07.3616
AJR 2008; 191:W89-W95
© American Roentgen Ray Society
Radiologic Features of Polyacrylamide Gel Mammoplasty
Sze Yiun Teo1 and
Shih-chang Wang2
1 Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100
Bukit Timah Rd., Singapore 229899.
2 Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore.
Received January 3, 2008;
accepted after revision March 14, 2008.
Address correspondence to S. Y. Teo
(Teo.Sze.Yiun{at}kkh.com.sg).
WEB
This is a Web exclusive article.
Abstract
OBJECTIVE. The objective of our study was to describe the imaging
features of polyacrylamide gel breast implants in women with and those without
complications from mammoplasty.
CONCLUSION. Although polyacrylamide gel implants may mimic
conventional implants on both sonography and MRI in women who do not have
complications from mammoplasty, polyacrylamide gel implants have some
distinguishing features. The imaging appearance of polyacrylamide gel implants
is related to the technique of injection and whether there are any associated
complications. The implants are usually in a retroglandular location.
Mammography, sonography, and MRI can be used to evaluate short-term
complications, although MRI appears to be the most sensitive. Common
short-term complications include extravasation of polyacrylamide gel and
secondary infection, which may be related to lactation. The long-term
complications of polyacrylamide gel mammoplasty are unknown. Knowledge of the
appearances of polyacrylamide gel implants in women with and those without
complications from mammoplasty is useful in the radiologic evaluation of such
patients.
Keywords: breast augmentation • breast cancer • breast cancer screening • mammoplasty • polyacrylamide gel
Introduction
Polyacrylamide is formed from polymerization of acrylamide monomers. It is
a water-soluble biocompatible substance used in a diverse range of industries,
including food and paper production and waste and soil industries and in the
manufacture of biomedical, personal, and cosmetic products. In the latter two,
polyacrylamide functions as a binder and a foam builder and imparts emollient
properties to items such as cosmetics and soaps. Polyacrylamide is used in
biomedical industries in tissue models, as a carrier of drugs and hormones,
and for separation and purification of biomaterial
[1].
Polyacrylamide gel contains 2.5–5% of polyacrylamide suspended in
95–97.5% water [1,
2]. It has been available for
use in breast augmentation (known as Formacryl, Contura SA) since 1997 in
China and the former Soviet Union
[3,
4]. It is estimated that the
Kiev City Hospital of the former Soviet Union performed polyacrylamide gel
mammoplasty in approximately 300 women a year
[4]. Nonetheless, the true
incidence of polyacrylamide gel mammoplasty is not known because the procedure
tends to be performed in small hospitals and private clinics. The procedure
involves the injection of approximately 150–200 mL of polyacrylamide gel
into the retroglandular space of each breast at the inframammary crease or at
the upper region of the breast
[3,
5].
The purpose of this article is to describe the radiologic features of
polyacrylamide gel–augmented breasts and complications from mammoplasty
on mammography, sonography, and MRI. Except a previous article describing the
T1 and T2 signal characteristics of polyacrylamide gel in breast augmentation
[6], to our knowledge, the
radiologic findings of polyacrylamide gel implants and complications of
polyacrylamide gel mammoplasty have not been previously reported in the
English-language literature.
Materials and Methods
We obtained institutional review board approval for our study. Patients who
had undergone polyacrylamide gel mammoplasty and presented to our institutions
for breast imaging during a 25-month period from May 2005 to October 2007 were
included in our study. Eleven patients, all of whom had undergone sonography,
met our inclusion criteria. In addition to sonography, two patients had
undergone mammography and MRI, one had undergone MRI, and two had undergone
mammography. The imaging features were studied retrospectively in consensus by
two radiologists.
The mammographic technique used for the examinations was the same as that
used for routine mammography—that is, without implant displacement.
Unlike conventional saline or silicone implants that are palpable and thus can
be displaced for "pinched" views, in breasts with polyacrylamide
gel implants, the augmented breast has a natural feel and the implant cannot
be distinguished from native breast tissue.
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Fig. 1A —39-year-old asymptomatic woman (patient 2 in
Table 1) with polyacrylamide
gel implants who presented for breast cancer screening. Right mediolateral
oblique mammogram shows water-density polyacrylamide gel (arrows) in
retroglandular location anterior to pectoralis muscle with variable margin,
seen when interposed against more radiolucent retromammary fat. Focal
depression at anterior border of polyacrylamide gel is seen in upper outer
quadrant (craniocaudal view not shown) with adjacent opacity lying in its
concavity (open arrow).
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TABLE 1: Clinical Features and Radiologic Findings of 11 Patients with
Polyacrylamide Gel (PAAG)–Augmented Breasts
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Fig. 1B —39-year-old asymptomatic woman (patient 2 in
Table 1) with polyacrylamide
gel implants who presented for breast cancer screening. Sonogram shows opacity
to be due to ovoid globule of extravasated polyacrylamide gel
(calipers) lying within concavity at anterior border of
polyacrylamide gel (arrow), corresponding to mammographic
finding.
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Fig. 2A —30-year-old woman (patient 9 in
Table 1) with polyacrylamide
gel implants who presented with left-sided breast lump. Left mediolateral
oblique mammogram shows amorphous mass of water density that is
indistinguishable from adjacent breast tissues. Oval opacity (arrow)
in left upper breast, corresponding to site of breast lump, can be seen only
on mediolateral oblique view.
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Fig. 2B —30-year-old woman (patient 9 in
Table 1) with polyacrylamide
gel implants who presented with left-sided breast lump. Sonogram obtained at
12-o'clock position shows at least two hypoechoic well-circumscribed oval
masses of extravasated polyacrylamide gel with larger mass (L1) corresponding
to mammographic opacity. L2 = small mass.
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Fig. 2C —30-year-old woman (patient 9 in
Table 1) with polyacrylamide
gel implants who presented with left-sided breast lump. Sonogram of central
left breast shows typical appearance of polyacrylamide gel mammoplasty.
Retroglandular fluid collection contains multiple internal foci of varying
echogenicity, sizes, and distributions. Lack of intervening intramammary fat
between polyacrylamide gel, adjacent breast tissues (B), and pectoralis muscle
(P) may account for mammographic appearance. N = nipple.
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The patients ranged in age from 29 to 39 years (mean age, 32.5 years;
median age, 30 years). Ten patients had mammoplasty performed in China and one
in Indonesia. Some patients were embarrassed about having undergone this
procedure and were not forthcoming about the details.
Most of the patients (82%, n = 9) were symptomatic. The clinical
features and radiologic findings of each of the 11 patients are detailed in
Table 1. For descriptions of
the radiologic features in our patients, findings are categorized by patient
presentation: asymptomatic or symptomatic.
Results
Asymptomatic Patients
One mammography and two sonography studies were available for the two
patients who were asymptomatic.
Mammography—The polyacrylamide gel implants showed water
density similar to saline implants. The polyacrylamide gel was retroglandular
in location with an incomplete margin with the adjacent breast tissues. In one
patient (patient 2 in Table 1),
a focal depression at the anterior border of the polyacrylamide gel collection
with an adjacent opacity in the right upper outer quadrant was seen (Fig.
1A,
1B).
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Fig. 3A —39-year-old woman (patient 7 in
Table 1) with polyacrylamide
gel implants who presented with bilateral breast lumps. Right mediolateral
oblique (A) and right craniocaudal (B) mammograms show multiple
bizarre opacities throughout breast parenchyma bilaterally. Unlike images of
other patients in our series, which showed retroglandular prepectoral single
fluid collections, mammograms of this patient show intraglandular
polyacrylamide gel collections that are probably due to multiple
injections.
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Fig. 3B —39-year-old woman (patient 7 in
Table 1) with polyacrylamide
gel implants who presented with bilateral breast lumps. Right mediolateral
oblique (A) and right craniocaudal (B) mammograms show multiple
bizarre opacities throughout breast parenchyma bilaterally. Unlike images of
other patients in our series, which showed retroglandular prepectoral single
fluid collections, mammograms of this patient show intraglandular
polyacrylamide gel collections that are probably due to multiple
injections.
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Fig. 3C —39-year-old woman (patient 7 in
Table 1) with polyacrylamide
gel implants who presented with bilateral breast lumps. Axial
contrast-enhanced T1-weighted image with fat saturation of both breasts again
shows multiple bizarre polyacrylamide gel pools in both breasts.
Polyacrylamide gel collection shows thin regular rim enhancement similar to
that of breast cysts.
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Sonography—In both patients, polyacrylamide gel appeared as
an almost anechoic fluid collection in a retroglandular prepectoral location.
Multiple discrete foci of varying echogenicities, sizes, and distributions
could be seen in the polyacrylamide gel implants. The characteristics of
internal echogenic foci varied between breasts in the same patient (patient
1), suggesting the random nature of the foci. A thin discontinuous echogenic
line surrounded the fluid collections. Posterior to the polyacrylamide gel
collections, the pectoralis muscle was seen as a continuous structure with no
abnormal "step off," which typically can be seen posterior to a
silicone implant [7]. The
opacity in the right upper outer quadrant of patient 2 was due to a focal
lobule of extravasated polyacrylamide gel (Fig.
1A,
1B).
Symptomatic Patients
Three mammography, nine sonography, and three MRI studies were available
for the nine symptomatic patients. Three patients each presented with breast
pain, breast pain and swelling, and a breast lump or lumps. Three patients
were lactating; of these, two presented with unilateral pain and swelling and
the third presented with unilateral breast pain alone.
Mammography—Mammograms were available for patients 3, 7, and
9. In patients 3 and 9, polyacrylamide gel appeared amorphous and
indistinguishable from the adjacent breast tissues (Fig.
2A,
2B,
2C). In patient 7, a woman with
bilateral breast lumps, multiple bizarre, randomly distributed opacities of
varying shapes and sizes were seen bilaterally (Fig.
3A,
3B,
3C). This patient may have
received multiple injections of gel in each breast rather than a single
injection in each breast as in all of the other patients. A well-defined oval
density was present in the upper breast corresponding to the palpable breast
lump in patient 9.
Sonography—In all patients except patient 7, polyacrylamide
gel was present as a single globular fluid collection in a retroglandular
prepectoral location with variable internal echogenicity similar to the
asymptomatic patients. No intervening mammary fat was present between the
polyacrylamide gel collection, the adjacent breast tissue, and the pectoralis
muscle in patients 3 and 9. This may account for the amorphous appearance of
polyacrylamide gel on mammography. Sonography of patient 7 showed multiple
bizarre, randomly distributed lobules of polyacrylamide gel in the breasts
that corresponded to the mammographic findings. Some of the lobules were
likely due to extravasation of gel from the underlying injection site.
Including patient 7, extravasation of polyacrylamide gel was the most
common abnormal finding, seen in five (56%) of nine symptomatic patients, two
presenting with breast pain (patients 3 and 11) and three presenting with a
breast lump or lumps (patients 6, 7, and 9).
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Fig. 4A —29-year-old woman (patient 4 in
Table 1) with polyacrylamide
gel implants who presented postpartum with right breast pain and swelling;
patient was breastfeeding. Sonography images obtained at 12-o'clock position
of both breasts show increase in volume accompanied by increase in
echogenicity of polyacrylamide gel collection of affected breast (A)
compared with unaffected breast (B). Note retroglandular location of
polyacrylamide gel and hypertrophy of breast tissues compatible with lactating
state.
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Fig. 4B —29-year-old woman (patient 4 in
Table 1) with polyacrylamide
gel implants who presented postpartum with right breast pain and swelling;
patient was breastfeeding. Sonography images obtained at 12-o'clock position
of both breasts show increase in volume accompanied by increase in
echogenicity of polyacrylamide gel collection of affected breast (A)
compared with unaffected breast (B). Note retroglandular location of
polyacrylamide gel and hypertrophy of breast tissues compatible with lactating
state.
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Superimposed infection of the polyacrylamide gel collection was the next
most common abnormal finding in our series of symptomatic patients, seen in
three patients (33%; patients 4, 5, and 8). All three patients presented with
unilateral breast pain and swelling, and the former two were lactating. The
affected breast showed a marked increase in the size of the polyacrylamide gel
collection as well as a diffuse increase in its internal echogenicity to
midlevel echoes (Fig. 4A,
4B). The complicated
collection in patient 4 was aspirated under sonography guidance. This
procedure yielded a large amount of yellowish fluid with tiny bubbles and
debris.
Discrete anechoic foci were seen in the left pectoralis muscle of patient
10 that were separate from the polyacrylamide gel collection. It is unlikely
that the polyacrylamide gel migrated through the tough fascia overlying the
pectoralis muscle after the injection. Rather, we suspect that the gel was
erroneously introduced at the time of the injection.
MRI—MRI was available for patients 3, 7, and 8. The position
of the polyacrylamide gel collections was well depicted on MRI. All
collections were retroglandular in location, although some of the
polyacrylamide gel in patient 8 extended partly into and partly beneath the
right pectoralis major muscle (Fig.
5A,
5B,
5C). These findings were not
seen on sonography. Again, we suspect that extension of the polyacrylamide gel
in patient 8 was likely due to intramuscular injection of polyacrylamide
gel.
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Fig. 5A —37-year-old woman (patient 8 in
Table 1) with polyacrylamide
gel implants who presented with pain and swelling in left breast. Axial fast
spin-echo T2-weighted (A), axial fast spin-echo T1-weighted (B),
and axial contrast-enhanced fat-saturated T1-weighted (C) MR images of
both breasts at same level show intramuscular extension of polyacrylamide gel
(arrows, A and B) in asymptomatic right breast.
Polyacrylamide gel shows fluid density type of signal, appearing hypointense
on T1-weighted and hyperintense on T2-weighted sequences. Decrease in
T2-weighted signal and increase in T1-weighted signal of infected left-sided
polyacrylamide gel collection, which is increased in volume, are seen.
Irregular thickened rim enhancement surrounds affected collection
(arrows, C). Unaffected collection shows faint regular rim
enhancement. Note internal hypointense T1-weighted and T2-weighted foci in
both collections, with more numerous foci in affected collection.
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Fig. 5B —37-year-old woman (patient 8 in
Table 1) with polyacrylamide
gel implants who presented with pain and swelling in left breast. Axial fast
spin-echo T2-weighted (A), axial fast spin-echo T1-weighted (B),
and axial contrast-enhanced fat-saturated T1-weighted (C) MR images of
both breasts at same level show intramuscular extension of polyacrylamide gel
(arrows, A and B) in asymptomatic right breast.
Polyacrylamide gel shows fluid density type of signal, appearing hypointense
on T1-weighted and hyperintense on T2-weighted sequences. Decrease in
T2-weighted signal and increase in T1-weighted signal of infected left-sided
polyacrylamide gel collection, which is increased in volume, are seen.
Irregular thickened rim enhancement surrounds affected collection
(arrows, C). Unaffected collection shows faint regular rim
enhancement. Note internal hypointense T1-weighted and T2-weighted foci in
both collections, with more numerous foci in affected collection.
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Fig. 5C —37-year-old woman (patient 8 in
Table 1) with polyacrylamide
gel implants who presented with pain and swelling in left breast. Axial fast
spin-echo T2-weighted (A), axial fast spin-echo T1-weighted (B),
and axial contrast-enhanced fat-saturated T1-weighted (C) MR images of
both breasts at same level show intramuscular extension of polyacrylamide gel
(arrows, A and B) in asymptomatic right breast.
Polyacrylamide gel shows fluid density type of signal, appearing hypointense
on T1-weighted and hyperintense on T2-weighted sequences. Decrease in
T2-weighted signal and increase in T1-weighted signal of infected left-sided
polyacrylamide gel collection, which is increased in volume, are seen.
Irregular thickened rim enhancement surrounds affected collection
(arrows, C). Unaffected collection shows faint regular rim
enhancement. Note internal hypointense T1-weighted and T2-weighted foci in
both collections, with more numerous foci in affected collection.
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In the absence of inflammatory change, the MRI signal of polyacrylamide gel
was similar to that of water and polyacrylamide gel appeared hypointense and
hyperintense on T1 and T2 sequences, respectively. A discontinuous thin
hypointense T2 rim was seen. In the polyacrylamide gel collection itself,
small discrete hypointense T2 foci were evident; these foci may be the
internal foci that were seen on sonography.
Extravasated polyacrylamide gel on MRI appeared similar to that on
sonography with discrete globules of fluid signal in the breast tissues.
Extravasated gel was present in patient 3 and was presumed to be present in
patient 7 (Fig. 3A,
3B,
3C).
Superimposed inflammatory change, increased heterogeneous intermediate T1
signal, and decreased heterogeneous hypointense to intermediate T2 signal,
together with irregular and thickened rim enhancement, were seen in patient 8
(Fig. 5A,
5B,
5C). A thin regular rim of
delayed enhancement was present around the polyacrylamide gel collection in
the asymptomatic right breast of patient 8 and surrounding the multiple
globules of polyacrylamide gel in patient 7 and appeared similar to the rim
enhancement of breast cysts.
Discussion
Polyacrylamide gel mammoplasty has been performed in many women in the
former Soviet Union, in China, and in other parts of Asia. The increasingly
common migration of women from those regions around the world means that more
radiologists worldwide are likely to interpret images of patients with these
implants. The appearance of polyacrylamide gel on various imaging techniques
seems to be related to the way it is mixed before injection; where it is
injected into the breast; and the type of complication or complications, if
any.
In all of our patients except one, polyacrylamide gel was located as a
single fluid collection in the intended retroglandular location. In the
patient with multiple lobules, multiple injection sites are suspected. In 18%
of our patients, imaging showed polyacrylamide gel extending into the
pectoralis muscle. This feature has been noted in other series
[5,
6]; we postulate that extension
of the gel is due to erroneous intramuscular injection at the time of the
procedure.
On mammography, polyacrylamide gel is of water density similar to saline
implants. A margin surrounding the polyacrylamide gel collection is present
and varies depending on the amount of intramammary fat. Sonography of an
uncomplicated polyacrylamide gel collection typically shows an almost anechoic
fluid collection with multiple discrete internal foci. On MRI, uncomplicated
polyacrylamide gel is of water density and may contain internal hypointense T2
foci. These internal foci may correspond to those seen on sonography and may
be air bubbles, impurities, or debris. An uncomplicated polyacrylamide gel
collection may show delayed thin regular enhancement similar to breast
cysts.
A thin discontinuous hypointense T2 boundary on MRI and a thin
discontinuous echogenic line on sonography often outline the polyacrylamide
gel collection. This bound ary may be the fibrous capsules surrounding
polyacrylamide gel collections found at open surgery
[3,
5,
6]. On pathology, thin fibrous
tissue and foreign body reaction composed of macrophages and foreign body
giant cells were commonly seen surrounding polyacrylamide gel pools in
lumpectomy specimens and breast tissue samples
[2,
4]. Foreign body reaction
appears to be related to the size of the polyacrylamide gel collection because
it was found around collections larger than 0.5 cm; small collections elicited
a much weaker foreign body reaction.
Polyacrylamide gel sometimes was not mass-producing but, rather, displayed
inter-digitating strands between the connective tissue or fat tissue with no
adjacent cellular reaction [4].
The thick fibrous capsules and calcifications typically associated with
silicone implants were absent. Chronic inflammatory cells could occasionally
be seen in the polyacrylamide gel
[2,
4]. Foreign body granulomas
resembling silicone granulomas were uncommon, seen in approximately 20% of
biopsy samples in one study
[4]. Unlike silicone
granulomas, polyacrylamide gel granulomas tend not to have significant
fibrosis.
When examining images of a patient with polyacrylamide gel–augmented
breasts, the challenge is to recognize the implants as such. Sometimes
patients may not be forthcoming with relevant history.
Differentiating polyacrylamide gel implants from silicone implants on
mammography is straightforward because silicone appears denser than
polyacrylamide gel. The thin dense line representing the shell of a saline
implant is easily recognized mammographically. Sonographic findings may be
confusing because some silicone implants have echogenic foci within them.
These foci, however, tend to be fairly regularly distributed compared with the
random distribution of foci within a polyacrylamide gel collection. On
sonography alone, it is possible to mistake a polyacrylamide gel implant for
an uncomplicated conventional implant. The two or three thin echogenic lines
of the shell and capsule of a conventional implant are distinctive. The
"stepoff" artifact behind silicone implants does not occur behind
polyacrylamide gel implants presumably because there is no significant
difference between polyacrylamide gel and breast tissue in the speed of sound
transmission. On MRI, a retroglandular collection of water density may mimic a
saline implant, but a saline implant is not expected to have any discrete foci
within it.
Complications arising from polyacrylamide gel breast augmentation usually
occur a few years after the procedure and include breast lumps, pain,
infection, and unsatisfactory cosmesis
[3,
6]. In our series, there were
equal numbers of patients each with breast pain, breast pain and swelling, and
a breast lump or lumps. In other series, the most common complication was a
breast lump or lumps [2,
3,
5]. Superimposed infection
resulting in breast pain and swelling was common in our series, making up a
third of the symptomatic patients. This high incidence of infection may
reflect a selection bias given the small number of patients.
Unlike traditional saline or silicone implants that herniate through the
thinnest portion of the surrounding fibrous capsule
[7], herniation and subsequent
extravasation of polyacrylamide gel seem to occur anywhere. In our series,
extravasation of gel was the most common abnormal finding, seen in five of
nine symptomatic and one of two asymptomatic patients.
We found that superimposed infection resulted in distinctive changes in the
appearance of a polyacrylamide gel collection that can be detected on
sonography and MRI. Mammography was not performed on any of these patients. On
sonography, the gel collection showed an increase in size and echogenicity. On
MRI, there are alterations in signal intensity and irregular thickened rim
enhancement. These features have not been described previously, to our
knowledge. Superimposed inflammatory change appears to be a common
complication associated with lactation, also noted in another series
[4]. Histologic examination of
one of these affected collections in our series revealed inflammatory cells
and granular debris. It is possible that polyacrylamide gel, a large fluid
collection with no physical boundaries, is prone to and easily allows
intracollection inflammation, especially in women who are breastfeeding.
Mammography, sonography, and MRI may be used for the assessment of
complications associated with polyacrylamide gel mammoplasty, which may be
present even if the patient is asymptomatic. Extravasation of polyacrylamide
gel was detected on mammography in one asymptomatic patient but was missed in
another patient; the latter case was subsequently shown on sonography and MRI.
MRI revealed intramuscular polyacrylamide gel that was not detected on
sonography in one patient. MRI is probably the most sensitive technique in the
assessment of complications of polyacrylamide gel mammoplasty. Sonography is
easily available and may be preferable to mammography given the young age of
these patients. Sonography can also be used to provide guidance for aspiration
of inflamed collections. Aspiration is both diagnostic and therapeutic because
bacteriologic studies aid in choosing antibiotic therapy and aspiration of
sufficient amounts may alleviate symptoms.
Our observations were limited by the small numbers in this series and by
the lack of corresponding mammography, sonography, and MRI studies for all
patients. This study was also in part limited by the young age of the
patients, resulting in a preference for sonography or MRI. Additional
long-term studies with more patients would be contributory.
Women with polyacrylamide gel–augmented breasts will be encountered
when they become candidates for breast cancer screening. Mammographic
screening is feasible provided that the gel has not been injected in multiple
locations throughout the breast. We believe that standard mediolateral oblique
and craniocaudal views will suffice in most patients. Pinched views obtained
for conventional implants may not be possible in this setting because
polyacrylamide gel cannot reliably be distinguished from native breast tissue
or portions of gel may have extravasated. Presumably, an underlying opacity
may be obscured by the presence of polyacrylamide gel. Conversely,
extravasated polyacrylamide gel may masquerade as a "mass" on
mammography. Therefore, assessment for suspicious calcifications and for
distortions of the underlying visible breast parenchyma should be the main
goal of screening mammography. Sonography and MRI constitute important tools
for the workup of patients with abnormal mammography findings.
The long-term complications of polyacrylamide gel mammoplasty are not
known. Polyacrylamide molecules in cosmetic preparations do not appear to
penetrate the skin and have not been reported to be toxic in oral studies
[1]. However, the acrylamide
monomer is present in all polyacrylamide preparations as a by-product in
polymerization. Its levels are not constant, ranging from < 0.1% to 0.1%
[1]. There are also concerns of
possible degradation of polyacrylamide into monoacrylamide. Monoacrylamide is
both a neurotoxin and a tumor initiator and has been shown to increase the
incidence of mammary gland tumors in female rats
[1].
In conclusion, many women who have undergone polyacrylamide gel mammoplasty
are now presenting with complications associated with the procedure. The
long-term effects of polyacrylamide gel mammoplasty are unknown. Imaging this
population of women has implications for routine screening and diagnostic
work. Mammography, sonography, and MRI may be used in the assessment of
short-term complications, although MRI appears to be the most sensitive.
Mammographic breast cancer screening can still be performed in eligible women.
Knowledge of the normal radiologic appearances of polyacrylamide
gel–augmented breasts as well as of complications associated with
polyacrylamide gel mammoplasty is useful in the accurate diagnosis and
sometimes in the treatment of such patients.
References
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Abstract
Introduction
