To compare two surgical methods for removal of polyacrylamide hydrogel.

We retrospectively analyzed the clinical data of 213 patients who underwent surgery to remove polyacrylamide hydrogel in their breasts in the Third People’s Hospital of Chengdu from June 2012 to December 2018. χ² test was used to compare concomitant symptoms (pain, nodes, redness and swelling, ulcer, nipple discharge and breast enlargement) between 61 patients receiving minimally invasive aspiration (aspiration group) and 152 patients receiving open surgery to remove hydrogel and capsule via an areola incision (open surgery group). The age and the surgical parameters(the operation time, bleeding volume and postoperative drainage time) was expressed as M (P₂₅, P₇₅) because of skewed distribution. The rank sum test was used to compare the age and the surgical parameters between two groups. The χ² test for trend was used to compare the proportion of patients receiving two different surgeries year by year.

(1) The aspiration group had a lower incidence of preoperative pain and more patients without concomitant symptoms compared with open surgery group [29.5%(18/61)vs 50.7%(77/152), χ²=7.881, P=0.005; 52.5%(32/61) vs 29.6%(45/152), χ²=9.850, P=0.002]. There was no significant difference in the incidence of other concomitant symptoms (nodes, redness and swelling, ulcer, nipple discharge and breast enlargement) between two groups (χ²=3.323, 3.349, 2.869, 0.000, 0.020; P all>0.050). (2) The operation time and bleeding volume in open surgery group were significantly higher than those in aspiration group [141(120, 190) min vs 90(76, 116) min, Z=-8.719, P<0.001; 20(10, 20) ml vs 10(5, 20)ml, Z=-6.076, P<0.001]. There was no significant difference in postoperative drainage time between two groups [5(5, 6) d vs 5(5, 6) d, Z=0.111, P=0.912]. (3) Since 2012, more patients chose open surgery and the trend presented a significant difference between two groups (χ²=6.936, P=0.008).

Compared with minimally invasive aspiration, open surgery is more traumatic and difficult, but it can remove polyacrylamide hydrogel to the maximum and clear the residual capsule and degenerated tissues. Open surgery is preferred in patients with long-time polyacrylamide hydrogel breast augmentation and more concomitant symptoms.