{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:16:57Z","timestamp":1788419817027,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Polyacrylamide hydrogels (PAAG), commercially known as Amazingel, have been widely used for injectable breast augmentation in China since the early 2000s. Because PAAG is non-degradable, long-term retention in the body may lead to complications, including infection, granuloma formation, and induration. Concerns regarding its potential long-term carcinogenicity have also emerged. However, breast cancer developing after PAAG injection has rarely been reported, and cases occurring more than 20 years after injection are exceptionally rare. Previous reports have not described ulcerative presentations or detailed molecular subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a case of unilateral ulcerative breast cancer that developed 20 years after PAAG injection for breast augmentation. Following removal of the injected PAAG material and surgical debridement, the infection was controlled, and histopathological examination confirmed invasive ductal carcinoma. Immunohistochemistry demonstrated ER (3+), PR (3+), HER2 (2+), whereas Fluorescence\n                      <jats:italic>in situ<\/jats:italic>\n                      hybridization (FISH) testing suggested a HER2-negative status. Endocrine therapy was subsequently initiated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>To our knowledge, this is the first reported case of ulcerative breast cancer occurring 20 years after PAAG injection for breast augmentation. The tumor exhibited a molecular profile of particular interest, characterized by robust hormone-receptor positivity and low HER2 expression. Ultra-long-term retention of PAAG may show a temporal association with breast cancer development, highlighting the need for long-term clinical surveillance decades after injection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1952422","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:45:08Z","timestamp":1788417908000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Ulcerative breast cancer occurring 20 years after breast augmentation with Amazingel injection"],"prefix":"10.3389","volume":"16","author":[{"given":"Tian","family":"Li","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital.","place":["Jinhua, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital.","place":["Jinhua, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyao","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Hangzhou Women\u2019s Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"475","DOI":"10.21037\/atm.2020.03.68","article-title":"Comprehensive management of breast augmentation with polyacrylamide hydrogel injection based on 15 years of experience: a report on 325 cases","volume":"8","author":"Qian","year":"2020","journal-title":"Ann Transl Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.cjprs.2022.11.003","article-title":"A review of complications of polyacrylamide hydrogel injection","volume":"3","author":"Xiong","year":"2022","journal-title":"Chin J Plast Reconstr Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-008-9298-4","article-title":"Breast cancer following augmentation mammaplasty with polyacrylamide hydrogel (PAAG) injection","volume":"33","author":"Cheng","year":"2009","journal-title":"Aesthet Plast Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000499832","article-title":"Clinicopathological analysis of 90 cases of polyacrylamide hydrogel injection for breast augmentation including 2 cases followed by breast cancer","volume":"15","author":"Yang","year":"2020","journal-title":"Breast Care"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2903\/j.efsa.2022.7293","article-title":"Assessment of the genotoxicity of acrylamide","volume":"20","author":"Benfor","year":"2022","journal-title":"EFSA J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-024-04259-9","article-title":"Clinical experience in the management of the polyacrylamide hydrogel (PAAG) associated complications including four breast cancer cases: a retrospective study of 135 cases","volume":"49","author":"Guan","year":"2024","journal-title":"Aesthet Plast Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"77","DOI":"10.14449\/jbd.2022.10.2.77","article-title":"Augmentation mammoplasty using polyacrylamide hydrogel injection can mimic breast cancer after 20 years: a case report","volume":"10","author":"Choi","year":"2022","journal-title":"J Breast Dis"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2025.110828","article-title":"Single-cell RNA sequencing reveals prolonged polyacrylamide hydrogel stimulation in vivo leads to an immunosuppressive microenvironment and potential tumorigenesis","volume":"196","author":"Liu","year":"2025","journal-title":"Comput Biol Med"},{"key":"B9","article-title":"Breast implant (PIP), chronic inflammation and cancer: is there a connection? 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