Multiple bilateral breast hematomas as a complication of polyacrylamide hydrogel injection for breast augmentation: A case report

We present the case of a female patient who underwent polyacrylamide hydrogel (PAAG) injection for breast augmentation 21 years ago and developed bilateral breast pain 2 years prior to evaluation. Preoperative magnetic resonance imaging (MRI) did not reveal any hematoma formation. However, intraoperative findings included multiple mural masses composed of dark red, fibrous clots, which were subsequently diagnosed as chronic organized hematomas. This case illustrates that organized hematoma may represent a distinct subtype of PAAG-related complications, likely resulting from long-term interactions between the physicochemical properties of PAAG and the local tissue microenvironment. It also highlights the diagnostic limitations of imaging in complex PAAG-associated pathology, suggesting that imaging should serve as an adjunct rather than a sole determinant in surgical decision-making. For patients with persistent pain or morphological changes of the breast, surgical exploration should be considered even in the absence of characteristic imaging findings. For asymptomatic patients, surgical intervention may also represent a beneficial option.