Mammographic and ultrasonographic study of patients who underwent breast augmentation through injection of hyaluronic acid (Macrolane )

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1 Mammographic and ultrasonographic study of patients who underwent breast augmentation through injection of hyaluronic acid (Macrolane ) Poster No.: C-1631 Congress: ECR 2011 Type: Scientific Paper Authors: M. P. Becchere, C. Rubino, F. Farace, A. S. Cossi, L. Simbula, G. Cipiciani, G. B. Meloni; Sassari/IT Keywords: Breast, Mammography, Ultrasound, Treatment effects, Diagnostic procedure DOI: /ecr2011/C-1631 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 22

2 Purpose At the present time several methods exist to obtain volumetric augmentation of breasts. Materials used for this purpose can be categorised into encapsulated and nonencapsulated. The latter type includes substances of different nature (fat, silicone, paraffin, hyrdocarbons, polyacrylamide...), varying in consistency from liquid to gel-like, 1,2 and requires just local injection. Macrolane is a gel belonging to nonencapsulated fillers; it's one of the newest products of its kind, and derives from hyaluronic acid. It's been 2 thought to be injected into soft tissues and then resorbed over about 12 months. The aim of this study is to assess Macrolane's impact on diagnostic accuracy of mammography and breast ultrasounds. Methods and Materials Seven patients ranging from 27 to 35 years of age (average 30) were studied in the period between september 2009 and july 2010 at Senology Unit of Institute of Radiological Sciences "C.Bompiani" - University of Sassari. Patients underwent bilateral aesthetic breast augmentation using intramammary injection of Macrolane. All patients had undergone preliminary studies at other centers through mammography and/or breast ultrasounds, depending on their age. No patient had family history of breast cancer. Macrolane volumes from 60 to 80 ml per breast had been injected through a cannula and under local anesthesia, deeply into soft tissues of virtual retro-mammary space. Injection had been done 8 months, 6 months and 1 month before, respectively in 3, 2 and 2 patients. All patients came to our attention because of breast pain of different level. Five patients, over 30 years of age, were studied through bilateral mammography and breast ultrasounds with high frequency probe (7-15 MHz); two patients, under 30 years of age, underwent just ultrasounds. Follow-up examinations were performed at months on a case by case basis, but only 3 patients completed 12-months follow-up. Results Page 2 of 22

3 In all patients, intramammary Marcolane seriously compromised diagnostic accuracy of mammography and breast ultrasounds. Macrolane determined the presence of gross radiopacities with lobulated contour on mammograms, inseparable on different views; at US examination, these findings appeared as widespread cystic-like deposits of hypoanechoic material, varying from a few millimeters to centimeters. Ultimately, our ability to view mammary tissue through both mammography and ultrasounds decreased because it was not possible to detect benign lesions with diameter of 1 cm (fibroadenomas) that had been identified before Macrolane injection. We also noticed that filler was still present at 12-months follow-up, most likely inside pseudoencapsulated formations. Moreover, ultrasounds showed that Macrolane had penetrated into muscles in two cases and parasternal soft tissues in one case; in this latter patient, surgical removal was necessary. Page 3 of 22

4 Fig.: Patient n 1: bilateral mammograms (CC projection) before Macrolane (TM) injection References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 4 of 22

5 Fig.: Patient n 1: bilateral mammograms (MLO projection) before Macrolane (TM) injection References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 5 of 22

6 Fig.: Patient n 1: mammographic examination (CC projection) after 6 months References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 6 of 22

7 Fig.: Patient n 1: mammographic examination (MLO projection) after 6 months References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 7 of 22

8 Fig.: Patient n 1: ultrasonographic aspect of breast at 6-months examination: voluminous anechoic deposits with patchy inner echoes References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 8 of 22

9 Fig.: Patient n 1: mammographic examination (MLO projection) after 12 months; some opacities persist. References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 9 of 22

10 Fig.: Patient n 1: ultrasonographic aspect at 12-months examination. References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 10 of 22

11 Fig.: Filler infiltration into the tissues, shown by the irregular upper border of accumulation. References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Page 11 of 22

12 Fig.: Filler infiltration into muscles and parasternal soft tissues. References: Becchere MP - Istituto di Scienze Radiologiche "C. Bompiani", Università di Sassari, Sassari, ITALY 2010 Images for this section: Page 12 of 22

13 Fig. 1: Patient n 1: bilateral mammograms (CC projection) before Macrolane (TM) injection Page 13 of 22

14 Fig. 2: Patient n 1: bilateral mammograms (MLO projection) before Macrolane (TM) injection Page 14 of 22

15 Fig. 3: Patient n 1: mammographic examination (CC projection) after 6 months Page 15 of 22

16 Fig. 4: Patient n 1: mammographic examination (MLO projection) after 6 months Page 16 of 22

17 Fig. 5: Patient n 1: ultrasonographic aspect of breast at 6-months examination: voluminous anechoic deposits with patchy inner echoes Page 17 of 22

18 Fig. 6: Patient n 1: mammographic examination (MLO projection) after 12 months; some opacities persist. Page 18 of 22

19 Fig. 7: Patient n 1: ultrasonographic aspect at 12-months examination. Page 19 of 22

20 Fig. 8: Filler infiltration into muscles and parasternal soft tissues. Page 20 of 22

21 Fig. 9: Filler infiltration into the tissues, shown by the irregular upper border of accumulation. Page 21 of 22

22 Conclusion The use of Macrolane as intamammary filler requires just local anesthesia and a simple 2 and minimally invasive procedure, most likely with a low risk of allergic reactions. Anyway, in our study this product caused serious diagnostic drawbacks. In addition to the reduced diagnostic accuracy, Macrolane determined unsatisfactory aesthetic results and some clinical problems such as hard swelling, aching at palpation. In literature, some cases are reported about systemic infections following injection of Macrolane and other cases of visible and palpable lumpiness, corresponding to multiple pockets where the filler was enclosed by a capsule, similar to that around breast 2 implants. In our experience, we advise against using Macrolane because of the complications linked to this product and diagnostic obstacles to cancer detection through mammography and ultrasounds, although its use requires a simple, fast and minimally invasive procedure. References McCleave MJ, Is Breast Augmentation Using Hyaluronic Acid Safe?, Aesth Plast Surg (2010) 34; McCleave MJ, Grover R, Jones BM, Breast enhancement using Macrolane : A report of complications in three patients and a review of this new product, Journal of Plastic, Reconstructive and Aesthetic Surgery (2010) xx, 1-4 Personal Information Page 22 of 22