Polyacrylamide hydrogel (PAAG) breast injections were widely performed across China, Russia, and parts of Eastern Europe in the 1990s and early 2000s. This is a clinical guide for patients now experiencing complications and seeking removal.
PAAG (polyacrylamide gel), marketed under brand names including Amazingel and Interfall, was injected into the breast as an augmentation filler between approximately 1997 and 2006. It was presented as a permanent, biocompatible alternative to implant surgery. In China alone, an estimated 300,000 women received PAAG injections during this period, primarily through cosmetic clinics rather than hospital surgical departments.
The material was subsequently banned in China in 2006 following accumulating evidence of delayed complications. Decades later, a significant proportion of these patients are now presenting for removal — either because symptoms have developed, or because they are seeking the procedure proactively.
Polyacrylamide is a synthetic polymer gel that is approximately 97.5% water. At the time of injection, it behaves as a cohesive, localised mass. Over time, however, several processes occur:
Symptoms vary widely. Some patients are asymptomatic for many years before developing pain, hardness, asymmetry, or skin changes. Others develop acute infections. A small number present with systemic inflammatory symptoms. Because PAAG interferes with mammographic imaging, it also creates ongoing diagnostic uncertainty in breast cancer screening.
PAAG removal is categorically different from implant explantation. A silicone implant is a discrete, encapsulated object that can be removed in a single operation. PAAG, by the time most patients present for removal, is not a contained mass. It has migrated into tissue planes, fragmented, and become incorporated into fibrous scar tissue. Complete removal is technically demanding and, in many cases, impossible without causing unacceptable collateral tissue damage.
The surgical objectives are therefore defined as maximal removal — removing as much accessible gel as possible while preserving the structural integrity of the breast, the pectoral muscle, and the overlying skin.
Most removal procedures are performed through an inframammary or periareolar incision, with exploration of all affected tissue planes under direct vision. Gel deposits are debrided as completely as possible. Where gel has infiltrated the pectoral muscle, partial muscle resection may be necessary. Where it has tracked to the axilla, a separate axillary approach is often required.
The procedure is performed under general anaesthesia and typically takes two to four hours, depending on the extent of migration and fibrosis. It is demanding work: the anatomy is distorted, the tissue planes are obliterated by scar, and the surgeon must simultaneously maximise removal and preserve sufficient tissue for reconstruction.
Following PAAG removal, the breast is typically deflated, asymmetric, and scarred. The degree of deformity depends on how much tissue was removed, how extensively the gel had migrated, and how the remaining breast tissue responds to surgery. For most patients, reconstruction is a natural next step.
The timing and method of reconstruction depend on the post-removal condition of the breast. Options include:
Why this procedure is best performed at a specialist centre: PAAG removal requires surgeons with direct experience of the specific tissue environment created by gel migration and fibrosis. It is not a procedure that can be extrapolated from standard breast surgery. Ninth People's Hospital has managed PAAG complications since the material was banned, and the reconstructive plastic surgery department has extensive experience with both the removal procedure and subsequent breast reconstruction.
If you are a PAAG patient seeking assessment, the most useful information to provide is: the year and approximate location of the original injection; any subsequent symptoms, treatments, or aspirations; current imaging (ultrasound or MRI, if available — note that mammography is often unreliable in PAAG patients); and photographs documenting current breast appearance and any visible asymmetry or skin changes.
Our reconstructive team reviews PAAG cases from patients across Asia and internationally. Every case is assessed individually — the extent of migration, your current symptoms, and your reconstruction goals all shape the surgical plan.
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