Endoscopic-assisted removal of injectable Amazingel with or without immediate prepectoral implant-based breast augmentation: safety and aesthetic outcomes from a retrospective study.

[BACKGROUND] Polyacrylamide hydrogel, commercially referred to as Amazingel, was prohibited for use in China in 2006 owing to its associated high complication rates. Conventional techniques for its removal are frequently insufficient to achieve complete eradication, often leading to persistent complications and suboptimal aesthetic results. This study aims to evaluate the safety and aesthetic outcomes of a novel transaxillary endoscopic-assisted removal of Amazingel (TERA) with or without immediate prepectoral implant-based breast augmentation (IPBA).

[METHODS] This retrospective study encompassed 42 patients who underwent TERA with or without IPBA between April 2020 and May 2025. Surgical safety was evaluated through the incidence of postoperative complications within the one-month postoperative period. Aesthetic outcomes were assessed three months after surgery using the Harris scale.

[RESULTS] The 42 patients were divided into two groups: 25 patients who underwent TERA with IPBA (the IPBA group) and 17 patients who underwent TERA alone (the N-IPBA group). A statistically significant improvement in aesthetic outcomes, as measured by the Harris scale, was demonstrated in the IPBA group compared to the N-IPBA group (P=0.01). Regarding safety, only one patient (2.38%) in the IPBA group developed a local infection, which was successfully managed with a course of oral antibiotics. Minimal residual Amazingel was detected on imaging in two patients (4.76%), with no associated discomfort.

[CONCLUSIONS] The findings of this study demonstrate that TERA with or without IPBA is a safe and effective method. The TERA technique facilitates a more thorough hydrogel removal and superior aesthetic results compared to conventional methods. Furthermore, the concomitant performance of IPBA significantly enhances postoperative patient satisfaction without elevating the risk of complications. These promising results warrant further validation through large-scale, multicenter prospective trials to generalize the findings.