PMC5994864_01
A: Clinical examination showing a 5 x 5 mm skin defect in the right breast with PAAG fistulation Fig. 1B: Follow up after 3 months.
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A 36-year-old Danish female who received breast augmentation with PAAG-injection in Iran 15 years earlier, presented with a 5 x 5 mm skin defect in the upper medial quadrant of the right breast 2 months after giving birth (Fig. 1A).
A: Ultrasound of right breast showing diffuse PAAG in the subcutaneous tissue and breast tissue (Arrow). B: Ultrasound of the left breast showing homogeneous distribution and intact skin (Arrow). C: X-ray of the right breast showing microcalcification in the remaining mammary tissue (Arrow). D: T2-weighted MRI-scan showing distribution of PAAG in both breasts and diffusion through m. pectoralis bilaterally (Arrow).
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Mammography of the right breast (Fig. 2C) revealed diffuse microcalcification density grade 4. Bilateral ultrasound showed inhomogeneous gelatinous material, thus ruling out any cyst or cancerous lump (Fig. 2A + B). Imaging (MRI) revealed that the injected PAAG material had diffused into the pectoralis major muscle bilaterally (Fig. 2D). Initial management strategy involved extraction of the material from the right breast.
HE-stain showing diffuse PAAG in the breast tissue with no bacteria.
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Microscopic evaluations showed no findings of any leukocytes or bacteria (Fig. 3).