PMC5005235_01
Intraoperative pictures. a The injected polyacrylamide hydrogel flow out with yellowish jelly-like appearance. b Simple mastectomy was done, and the hydrogel was removed with the infiltrated capsule
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Fig1
PAAG and immediate subpectoral smooth round silicon-implant reconstruction with Mentor MemoryGel  were performed for symptoms relief as well as potential malignancy concern (Fig. 1). Pathologic report showed PAAG gel surrounded by collagenous fibrous tissue.
(HE stain, original magnification x100, right lower: original magnification x400). The breast shows variable sized gelatinous pools, which are surrounded by collagenous fibrous tissue. In some areas, foreign body reaction characterized by infiltrated foreign body type multinucleated giant cells and macrophages is seen (right lower inset)
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Fig2
There was no evidence of acute inflammation such as polymorphonuclear leukocytes infiltration (Fig. 2).
Computed tomography image of hematoma formation on the 14th day post simple mastectomy and immediate subpectoral silicon-implant reconstruction. Pigtail drainage tube was inserted and 250 ml hematoma was drained out
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Fig3
Subcutaneous hematoma of around 250 ml was drained by diagnostic computer tomography (CT) scan guidance (Fig. 3).
Right pectoral muscle oozing (arrow) over the 2nd intercostal space 2 cm paramidline to sternum was found during exploration surgery. Intercostal perforator bleeding was suspected
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Fig4
For complete removal of the solitary residual hematoma, we did a secondary exploratory surgery where the lesion at the second intercostals space, 2 cm to the right of the sternum on the right pectoral muscle was noticed and coagulated (Fig. 4).