Introduction

Polyacrylamide gel was once a popular choice for breast augmentation, but its use has been fraught with complications, leading to its ban in many regions, including China in 2006. Women who had polyacrylamide gel injected into their breasts are now seeking medical help for its removal. In New York City, a new hospital ranking list for polyacrylamide gel injection removal from the breast has been released, which is of great significance for patients in need. This article will delve into various aspects related to this topic, including the complications of polyacrylamide gel injection, surgical methods for removal, top - ranked hospitals in New York City, and postoperative reconstruction.

Complications of Polyacrylamide Gel Injection

Reasons for the Ban

Polyacrylamide gel (PAAG) was introduced in 1997 as a soft - tissue filler for breast augmentation and contouring. Initially, it was considered a non - biodegradable, non - toxic, non - sensitizing, and non - teratogenic hydrogel. However, after long - term clinical application, many complications emerged. According to research such as the one in “Comprehensive management of breast augmentation with polyacrylamide hydrogel injection based on 15 years of experience: a report on 325 cases,” PAAG was banned by the Chinese Food and Drug Administration (CFDA) in 2006 due to several associated complications, including contour abnormalities, abnormal skin sensation, pain, induration, malignant breast tumors, aseptic inflammation, leakage, and hematoma.

Common Complications

Based on the study of 325 patients from 2003 to 2018, the top three complications were pain, induration, and deformation. Other complications include infection, displacement, milk deposition, and systemic symptoms like headaches, palpitations, hypodynamia, and upper limb numbness. Although there was no patient with breast cancer caused by PAAG in that particular study, several recent studies have reported the potential link between PAAG and breast cancer. For example, PAAG may decompose acrylamide monomers under multiple factors such as body fluids, various enzymes, and mechanical stimuli after injection into the body, with carcinogenic and toxic effects on the nervous and reproductive systems.

Mechanisms of Complications

PAAG is often injected into the retro - mammary pocket and forms a thin capsule that can break due to gravity, pressure, or trauma. It may then migrate along with the loose connective tissue and extend to adjacent areas, leading to changes in breast shape. Induration is usually caused by incorrect injection, improper postoperative massage, and uneven distribution of the PAAG. Pathology results of induration show extensive fibrous tissue proliferation generated by the stimulation of the PAAG. Pain may be related to tissue degeneration, local tissue adhesion, infection, and aseptic inflammation. Poor intraoperative disinfection and bacterial contamination of the filler may result in acute infection.

Surgical Methods for Polyacrylamide Gel Removal

Available Methods

Currently, there are three common methods for PAAG removal: blunt aspiration, direct visualization surgery, and endoscopic surgery. The efficiency of blunt aspiration is limited. The back - and - forth movement during aspiration can disseminate the PAAG, making its distribution more chaotic and causing more serious tissue damage. Scar formation and fibrous tissue hyperplasia after aspiration may increase the difficulty of possible secondary surgery. Even under the guidance of ultrasound, the suction method cannot completely remove the infiltrating capsule and fascia. For endoscopic surgery, although the incision and postoperative scar are better concealed, its insufficient exposure of the pocket results in a more complicated surgical operation with higher technical requirements and higher costs. Moreover, the surgical effect is not widely confirmed.

Recommended Method: Direct Visualization Surgery

Direct visualization surgery is recommended. There are two types of incision options for this surgery: the semi - peri areola incision and the inframammary fold (IMF) approach. The periareola incision provides a better surgical vision and is the easiest way to reach the surgical area. Its advantages include more efficient and safer removal of the hydrogel in the cyst completely, simultaneous removal of the infiltrated capsule and the surrounding extensive necrotic and degenerative tissues, utilization of the hydrophilicity of the hydrogel to make it easier to find and resect the PAAG nodules, and reduction of the residual PAAG content to the minimum by irrigating the pocket with saline repeatedly. However, the limitation is that the surgical incision is relatively small for patients with a small areola, and the operation is difficult in patients with the distant displacement of PAAG to the abdominal wall.

The IMF approach has some shortcomings. It is difficult or even impossible to dissect the infiltrated capsule and fascia through the IMF incision. The surgical area is not well - exposed, and it is difficult to clearly see the various quadrants of the breast compared to the areola incision, especially in patients with PAAG displacement to the subclavian and axilla region. Postoperative scars are also more obvious. But this approach has its own advantages in certain situations and is particularly suitable for the few patients in which the injection was shifted toward the abdominal wall and may cause relatively less damage to breast tissue compared with the periareola incision.

Top - Ranked Hospitals in New York City for Polyacrylamide Gel Removal

General Considerations

When looking at the new hospital ranking list for polyacrylamide gel injection removal from the breast in New York City, several factors are considered. These may include the hospital's experience in dealing with such cases, the expertise of its surgeons, the success rate of the surgeries, patient satisfaction, and the availability of advanced medical technology. Some of the well - known hospitals in New York City that may be on the list have a long - standing reputation for excellence in plastic and reconstructive surgery.

Notable Hospitals

Mount Sinai Hospital

Mount Sinai Hospital is a well - respected medical institution in New York City. It has a strong track record in multiple specialties. According to U.S. News & World Report's 2024 - 2025 rankings, it earned the No. 1 ranking in the United States for geriatrics. In terms of cancer treatment, it is nationally ranked in 12 adult specialties and 4 pediatric specialties. While the specific ranking for polyacrylamide gel removal from the breast is part of the new list, its overall reputation for high - quality medical care and surgical expertise suggests it could be a top - choice hospital. Its team of surgeons may have experience in handling complex cases related to breast surgeries, including the removal of PAAG.

Memorial Sloan Kettering Cancer Center

This center is renowned for its cancer treatment. It ranks #2 in cancer hospitals in New York according to U.S. News. Although its main focus is on cancer, the skills and technologies used in cancer - related breast surgeries may also be applicable to the removal of PAAG. The center has a team of highly trained surgeons and access to advanced diagnostic and treatment facilities. It may offer a comprehensive approach to PAAG removal, considering factors such as potential long - term complications and the need for breast reconstruction.

New York - Presbyterian Hospital - Columbia and Cornell

This hospital is nationally ranked in 14 adult specialties and 10 pediatric specialties for cancer treatment. It is affiliated with Columbia University and Weill Cornell Medicine, which means it has a large pool of highly qualified medical professionals and access to the latest research and technologies. Its plastic surgery department may be well - equipped to handle the removal of PAAG and subsequent breast reconstruction, with a focus on patient - centered care.

Perlmutter Cancer Center at NYU Langone Hospitals

The Perlmutter Cancer Center is nationally ranked in 13 adult specialties and 3 pediatric specialties. It has a comprehensive approach to cancer treatment and may also have experience in PAAG removal surgeries. The center may offer state - of - the - art imaging techniques for pre - operative planning and a team of surgeons who are familiar with the latest surgical methods for PAAG removal.

Post - operative Reconstruction

Importance of Reconstruction

Breast deformity after the removal of PAAG can have a serious negative impact on patients’ quality of life. Reconstructive surgery is often necessary to restore the natural shape of the breast and help patients regain their confidence. However, for security reasons, the indications for reconstructive surgery need to be strictly controlled. At least two points should be met: a strong desire in the patient for breast reconstruction and adequate healthy soft tissue for coverage of the prosthesis.

Timing of Reconstruction

Patients are divided into two groups for breast reconstruction: immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR). Patients with no signs of acute inflammation and no obvious PAAG residue in the implant pocket are candidates to undergo IBR. However, patients with acute inflammation, as well as those with unclear PAAG residue, can only be offered DBR based on the results of the review six months after the debridement operation. Breast reconstruction surgery is not recommended for patients with breast skin ulceration or for patients with severe gland and pectoralis major damage after the PAAG removal.

Placement of the Prosthesis

Although most studies recommend sub - pectoral or dual - plane breast reconstruction, some hospitals may prefer to place the implant into the residual cavity (pre - pectoral plane). This approach has several advantages. It is anatomically less invasive, technically less challenging, less time - consuming, and associated with less pain as it obviates the need to elevate the pectoralis major muscle. It also eliminates animation deformity and results in a more natural breast shape, particularly during the adduction of the humerus. Additionally, the incidence of possible hematoma and seroma is lower as a suitable prosthesis can fill the residual cavity.

Conclusion

The new hospital ranking list for polyacrylamide gel injection removal from the breast in New York City is a valuable resource for patients seeking treatment. Polyacrylamide gel injection has brought numerous complications to women who underwent breast augmentation with it. Surgical removal of PAAG is a complex process, and choosing the right hospital and surgical method is crucial. The top - ranked hospitals in New York City offer a combination of experienced surgeons, advanced technology, and comprehensive treatment options, including postoperative reconstruction. By considering factors such as the hospital's reputation, surgical expertise, and patient - centered care, patients can make more informed decisions about their treatment.

If you or someone you know is in need of polyacrylamide gel removal from the breast, take the time to research the hospitals on the new ranking list. Consult with medical professionals at these institutions to understand the details of the treatment process and the expected outcomes. Share this information with others who may benefit from it, and continue to explore related topics to stay informed about the latest developments in this field.