Eur J Plast Surg (2006) 29: 137–138
Commentary on “Late complications after application
of polyacrylamide hydrogel” by Evstatiev
Published online: 21 April 2006
# Springer-Verlag 2006
This paper is a summary of different complications noted
after injections of polyacrylamide hydrogel into different
parts of the human body; these were all performed by
doctors in other countries or institutions. Unfortunately,
there is a total lack of anamnestic data. The paper does not
give any information on who administered the injection or
where the injections had been placed or how many
injections had been given originally. It is essential to
know the origin of the gel, its sterility, and the conditions
under which the gel was originally injected.
There are no pre-injection or even pre-complication
photos and no information on indications for the injection.
It would also be important to know how many times the
patients with these complications had been injected at the
same site and if these injections had been performed under
The success of the result after gel injection is totally
dependent on the physician who uses it; this is borne out by
the finding of pathogenic microorganisms in seven cases.
Comments to the results section
How is partial necrosis of the skin defined? Was there an
ulcer? fibrosis? inflammation?
A reaction in the regional lymph glands. Was it verified
microscopically, and what did it show? Enlarged glands in
the axilla are a normal finding on palpation.
The mammography photo is useless, as it is under-
exposed. There is no contrast between gel and tissue. The
ultrasound photos could just as well stem from a normal
breast without gel having been implanted.
Comments to the discussion section
How can it be claimed that all of the complications are
related to the gel itself when it was truthfully acknowl-
edged in seven cases that microorganisms were discovered
and that inflammatory reactions were found in another
It is true that a fibrous capsule is not formed around the
gel but a rim of macrophages is formed around larger
deposits of the gel. It is said that hydrogel has been found
inside the tissues. Isn't that the purpose of the gel? We are
talking about a tissue filler!
Our experience confirms this concept? How? According
to the section Materials and methods, the author has no
experience with gel injection.
Comments to references
Reference no. 1 is the only reference which can be found in
PUBMED. Most other references are personal commu-
nications and congress abstracts; one was not even
presented at a congress.
The physical characteristics of hydrogel make it an
excellent tissue filler as a substitute for fat tissue. The
presence of pathogenic microorganisms is a complica-
tion risk which has to be taken into consideration with
any injection or with any form of implant (heart
valves, hip prostheses, and artificial blood vessels) as
it is well known that tissue resistance towards micro-
organisms is reduced.
One can agree on the fact that injecting anything into a
breast not previously operated upon may cause a risk of
suspicions of cancer due to micro-calcifications and
This commentary refers to the article http://dx.doi.org/10.1007/
I. Ankorina-Stark (*)
Contura International A/S,
Soeborg, DK-2860, Denmark
Holte Clinic of Plastic Surgery,