Cosmetic Injection

Cosmetic Injection

Shih-chang (Ming) Wang, FRANZCR



  • Polyacrylamide gel (PAAG)


  • Injection of oil, gel, or autologous fat into breast for cosmetic augmentation

    • Any cosmetic injection may result in foreign body granulomatous reaction or secondary infection

    • Typically performed in smaller clinics and beauty parlors

  • Paraffin from early 20th century, silicone since 1960s

    • Widespread once, now illegal in USA; still used in some parts of world (e.g., Asia, Mexico)

  • PAAG since late 1990s

    • Jelly-like transparent gel: 95-97.5% water and 2.5-5 % polyacrylamide, typical volume 150-200 mL

    • Used for gel electrophoresis, ophthalmic operations, drug treatment, food packaging, water purification

    • Used in plastic and aesthetic surgery since early 1990s (e.g., faciomaxillary reconstruction)

    • Used for breast augmentation since 1997

Anatomy-Based Imaging Issues


  • Appears as discrete blobs or confluent collections depending on injection technique, location

  • Intraparenchymal or retroglandular; may be periglandular

Imaging Recommendations

  • T1W, T2W images, fat suppression

  • Contrast-enhanced MR if inflammation or infection suspected clinically

MR Features

Signal Characteristics

  • T1W image

    • Paraffin, silicone, PAAG: Mildly hypointense

      • Signal may be increased in secondary infection

    • Injected fat: High-signal mass(es)

  • T2W image

    • Paraffin, silicone, PAAG: Hyperintense heterogeneous collections

    • Injected fat: High- or intermediate-signal mass(es)

  • T2W FS image, STIR

    • Paraffin, silicone, PAAG: Hyperintense

    • Injected fat may have normal or abnormal fat signal and thus variable degrees of suppression

    • Inflammation may appear hyperintense

    • Necrotic fat injections may show high signal fluid-filled cysts, especially if single large injection

  • T1W C+ image

    • Granulomas show variable enhancement

    • Rim enhancement around collections especially if inflammatory changes

  • Enhancement kinetics

    • Slow, with prolonged delayed enhancement

    • Resonant frequencies differ for each injected material

Differential Diagnosis

Other Fluid Collections

  • Silicone implant

  • Seroma or lymphocele

  • Abscess/infection

Clinical Considerations


  • Usually focal or diffuse lumps, hardening, deformity

  • Inflammation or frank infection, especially with PAAG, fat injections

  • Discomfort or pain

  • Silicone mastitis may have draining sinuses, ulceration, deformity


  • Predominantly Asian patients, also Eastern European

  • Also reported in male transsexuals

Implications and Management


  • Long-term adverse consequences unknown

  • No known association with breast cancer or collagen vascular disease


  • Infection and scarring may require local surgical removal or mastectomy in extreme cases

  • May impair ability to perform routine breast cancer screening

Selected References

1. Hyakusoku H et al: Complications after autologous fat injection to the breast. Plast Reconstr Surg. 123(1):360-70; discussion 371-2, 2009

2. Lui CY et al: Evaluation of MRI findings after polyacrylamide gel injection for breast augmentation. AJR Am J Roentgenol. 191(3):677-88, 2008

3. Teo SY et al: Radiologic features of polyacrylamide gel mammoplasty. AJR Am J Roentgenol. 191(3):W89-95, 2008

4. Erguvan-Dogan B et al: Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications. AJR Am J Roentgenol. 186(3):888-94, 2006

5. Qiao Q et al: Management for postoperative complications of breast augmentation by injected polyacrylamide hydrogel. Aesthetic Plast Surg. 29(3):156-61; discussion 162, 2005

6. Christensen LH et al: Long-term effects of polyacrylamide hydrogel on human breast tissue. Plast Reconstr Surg. 111(6):1883-90, 2003

7. Cheung YC et al: Lumpy silicone-injected breasts: enhanced MRI and microscopic correlation. Clin Imaging. 26(6):397-404, 2002

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Sep 18, 2016 | Posted by in OBSTETRICS & GYNAECOLOGY IMAGING | Comments Off on Cosmetic Injection
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