Severe systemic dissemination of copolyamide breast filler with multifocal abscess formation including mediastinal involvement: a case report

Copolyamide-based hydrophilic fillers, such as Aquafilling, have been used off-label for breast augmentation; however, their long-term safety remains uncertain. Here, we report a rare case of a 26-year-old woman who developed widespread, recurrent soft-tissue abscesses and an anterior mediastinal fluid collection several years after a copolyamide breast filler injection. The patient required multiple surgical interventions and prolonged antibiotic therapy, highlighting the risk of severe delayed complications. This case underscores the importance of patient education, vigilant monitoring, and clinical caution, particularly in recognizing the potential for late-onset systemic dissemination and complications such as migration and infection associated with copolyamide breast filler injections.