Sepsis 6 Years After Breast Augmentation With Aquafilling: A Case Report and Literature Review

Aquafilling is a hydrophilic gel composed of 98% physiological saline and 2% polyacrylamide gel, introduced in Japan in 2015 for breast augmentation. Despite its initial popularity, it has been associated with severe complications, including delayed infections, abscess formation, material migration, and fibrosis. In 2019, the Japanese Society of Aesthetic Plastic Surgery banned its use for breast augmentation due to safety concerns. However, cases of late-onset complications continue to emerge. Here, we report a case of sepsis caused by an abscess at the injection site 6 years after Aquafilling injection. A 34-year-old woman with a history of methamphetamine addiction underwent breast augmentation with Aquafilling. Six years later, she developed erythema, swelling, and fever, leading to sepsis. Contrast-enhanced computed tomography revealed abscess formation at the injection site. Surgical drainage and debridement were performed, and antibiotic therapy was tailored based on culture results. Postoperative management included intensive care unit care, repeated debridement, and wound closure with a split-thickness skin graft. The patient was discharged 55 days after admission. This case highlights the significant risks associated with nonabsorbable fillers, particularly delayed infections and their severe consequences. A review of the literature reveals numerous reports of similar complications worldwide, necessitating surgical intervention in most cases. To prevent such outcomes, rigorous safety evaluations and monitoring systems led by professional societies and governments are essential. Furthermore, a safety network for treating patients with late-onset complications must be established to ensure timely and effective care.