PAH injections into the breast

Case contributed by Dr Garth Kruger

Presentation

A 55 year old Ukranian woman presents with a mass in the axillary tail of the left breast.

Patient Data

Age: 55
Gender: Female
Modality: Mammography

The mammogram images show a non- specific homogeneous amorphous density in the submammary space. There were no previous studies for comparison. I am not sure what the "pipecleaner" linear densities are but because they are bilateral I suppose they may represent needle tracts from the introduction of the PAH ? In this patient the injection was from both axillas.

A palpable mass axillary tail of the left breast.

Modality: Ultrasound

The ultrasound images show a heterogenous tissue in the submammary space and on the left, tracking toward the axilla. In real time the substance can be seen to move, rotate  and swirl on ultrasound imaging. The middle image shows a small superficial simple cyst in the breast parenchyma.

Case Discussion

The case demonstrates PAH breast injections. Polyacrylamide hydrogel  (PAH) was one of the substances historically used to augment breast tissue (along with paraffin and silicon). It was used in this patient 20 years ago in what was then the Soviet Union. The needle injection was via the axilla or inframammary fold into the submammary space.

Not a common finding in Western Canada but I suppose it depends where you work. This case showed migration of the PAH from the submammary space toward the left axilla where it formed a palpable mass lesion.

The reference below is a very readable historical summary of the augmentation of breast tissue (and other protuberances) and well worth reading for some perspective if you are involved in senology. To my mind also a social commentary on who we are and who we would like to be.

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Case Information

rID: 27337
Case created: 30th Jan 2014
Last edited: 13th Mar 2016
System: Breast
Inclusion in quiz mode: Included

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