Breast augmentation with Aquafilling: complications and radiologic features of two cases

Breast augmentation with various injectable materials has been performed for decades. Aquafilling was developed in 2005 as soft tissue filler for facial contouring and recently its use for breast augmentation has gained speed in several countries. Its declared composition is 98% water and 2% copolyamide. Although not approved by the U.S. Food and Drug Administration, the procedure is increasingly applied in Turkey. Thus, familiarity with specific imaging findings and complications of this entity is important for the correct diagnosis. Possible migrated material should especially be sought for when reporting these cases. Hereby, we present two cases with a history of breast augmentation with Aquafilling, with special emphasis on MRI findings. Two female patients (ages 28 and 32) were referred for breast ultrasonography (US) with progressive swelling of the right breast (4 years after Aquafilling) and mastalgia (1 year after Aquafilling). Breast MRI at 1.5T (Siemens Espree) with 4-channel breast coil was performed. High-resolution non-fat sat T1- and T2-weighted (W) images, time of repetition-independent multislice (TRIM), and diffusion-weighted imaging (DWI), and for the silicone assessment, water-suppressed and fat-suppressed (WS-FS) sequences, were used. No contrast was administrated. Knowledge of the radiologic characteristics and migration patterns of Aquafilling material as well as related complications is very useful to make an accurate diagnosis. Level of Evidence: Level V, diagnostic study.