In short
- 🔑 “I am still unwell” hides four different problems: material left behind, symptoms persisting, not liking the contour, or something new having appeared. They are not resolved the same way.
- Material being left behind is what you would expect, not the exception. In a series of 135 breast patients there was residue in 17%, and other authors note that conventional techniques frequently fail to achieve complete eradication.
- Partial improvement is the most frequent result. In the available review, surgical excision achieved 48% complete responses and 50% partial ones.
- ⚠️ Nobody has measured how much material is really removed. The authors of the largest published series acknowledge it, and that is why “a lot was left in you” is rarely an objective statement.
- 🔑 Contour irregularity was the most frequent complication in the only study comparing reconstruction techniques. It is a problem of shape, and it has a solution of its own.
- ⚠️ What does demand looking at without waiting is anything new: infection, a wound that will not close, increasing pain or an area that is getting worse.
- A second opinion without paperwork is of little use. The surgical report, the earlier imaging and current imaging.
It is a very frequent consultation and it almost always arrives with the same mixture: disappointment, a suspicion that something was done badly and a fear of having spent money and been through theatre for nothing.
The first thing to say is uncomfortable but necessary: material being left behind, or discomfort persisting after removal, does not automatically mean the surgery was bad. In many cases it is what the literature describes as a normal result. In others it is not. Telling them apart is exactly what this page is for.
The process is in the guide to biopolymer removal and what it is reasonable to expect, in results to expect.
The four problems hiding behind “I am still unwell”
Separating them is half the work, because each has a different answer.
1. “I think material was left in me”
It is the most frequent, and also the most misinterpreted.
The published figures are clear in the uncomfortable direction: in the series of 135 patients operated on to remove breast hydrogel there was residue in 17%; in a series of 42 patients having endoscopic removal, minimal residue was detected on imaging in 4.76%, with no associated discomfort; and the authors of that same series note that conventional techniques are frequently insufficient to achieve complete eradication.
To that is added something even more important: the authors of the series of 199 gluteal removals conclude that studies are needed to quantify how much material is removed and to compare techniques. That is: there is as yet no objective measure of “how much should have been taken out”.
What can be done is to look at how much is there today, where, and whether that explains what is happening to you. An MRI says that, and it is in the diagnosis page.
2. “I am still in pain or still have symptoms”
This is a different one, and the key question is whether you improved at all or not at all.
In the available systematic review, surgical excision obtained 48% complete responses and 50% partial ones. Translated: almost everyone improves, but ending up halfway is the likeliest result. A partial improvement is not a failure of the surgery: it is the most frequent outcome.
That said: if you did not improve at all, or if you got worse, that does deserve review. And it deserves looking at two things: how much material is left and whether there is anything else explaining the symptoms other than the material.
3. “I do not like how it turned out”
It is a problem of shape and it has its own treatment, different from removing more.
In the only study comparing reconstruction techniques after removal of permanent filler — three groups of 160 patients — the most prevalent complication in all three was contour irregularity. It is not a rare failing: it is the typical problem of this surgery.
What is called for then is not reoperating to “take more out”, but assessing reconstruction: it is on the reconstruction page.
4. “Something new has appeared”
This is the category that does not allow waiting for the next appointment.
- A wound that opens, discharges or smells. Dehiscence appeared in 21.1% of the series of 199 patients: it is frequent, and it has to be looked at.
- A soft lump at a month. Probably a seroma, the most frequent complication, which appears on average at 31 days.
- Fever, spreading redness, increasing pain. That is not normal progression.
- An area that is getting worse weeks or months later.
What is and is not part of the process is in symptoms and warning signs.
What to take to a second opinion
Without these, a second opinion is little more than an impression:
| What to take | What it is for |
|---|---|
| The surgical report, with what was found and what was removed | It is the only document that says what was really there and what was done. Without it, an opinion is blind. |
| Imaging from before the surgery (MRI or ultrasound), with the images and not just the report | It allows comparison. It is the difference between “material is left” and “this much of what was there is left”. |
| Current imaging | It says what is there today, where, and what state the tissue is in. |
| Your history since the operation: complications, treatments, appointments | It distinguishes a healing problem from a material problem. |
| Blood tests, if you have any | Calcium and other markers can give information about how active the reaction is. |
If you do not have the surgical report, ask for it: it is your clinical record and you are entitled to a copy.
When reoperating makes sense and when it does not
It makes sense to consider when:
- Material is left that is related to the symptoms you have, and imaging places it somewhere reachable.
- There is infection, a collection or persistent inflammation that does not resolve with medical treatment.
- The problem is one of shape or coverage and what is needed is reconstruction, not further removal.
- New complications appear that require surgical treatment.
It usually does not when:
- There is minimal residue with no associated symptoms. That is what the literature describes as a frequent finding with no consequences.
- The expectation is “that nothing be left”. That is neither an achievable nor a measurable objective today.
- Only a few weeks have passed and the recovery is still under way: judging before it is resolved leads to no valid conclusion.
- The aim is to go back to the body you had before the injection, which no longer exists.
Yes, we assess surgery done elsewhere
It is the question almost everyone arrives at this page with, so it is answered without hedging: yes. We operate on secondary cases very regularly, and a substantial part of what we do with biopolymers is cases that started at another practice. The first operation does not have to have been done here, and you do not have to bring anything beyond what you have.
The pathway is always the same and it has two steps that are not skipped:
- First, an assessment. A consultation, an examination and a review of whatever you bring from the previous surgery. Nobody is going to tell you over the phone or from a photograph whether you need reoperating.
- And it is assessed with the MRI in front of us. The MRI is what says what is left, where it is and in which plane, which is exactly what cannot be deduced from the outside and what separates “there is still material” from “what you are feeling is the recovery”. How it is requested and what it shows is in the diagnosis page.
How long to wait after the previous surgery: at least 6 months, and ideally a year. It is not an administrative rule; it is that before then you would be deciding about tissue that is still reorganising — swelling, hardening that settles on its own, a scar that has not matured — and an MRI does not distinguish well between residual material and recent post-operative changes either. Reoperating too soon has a real cost: you operate on worse tissue and on a less reliable image.
⚠️ That timescale has one exception, and it is the one that matters: if what you have is an acute complication — infection, an abscess, a growing collection, fever — that does not wait six months and it is not a planned reoperation. It is an emergency and it is dealt with as one.
And if what you want is to make a claim
It is a legitimate question and a different one from the medical question. What is needed for that — the medical report and the expert-witness route — has its own page: reporting and making a claim.
It is worth separating for a practical reason: the clinical assessment and the claim are two different processes, and mixing them usually delays the first, which is the one that resolves your health problem.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
Material was left in me. Was the surgery done badly?
Not necessarily. Material being left is what you would expect: in a series of 135 patients there was residue in 17%, and conventional techniques frequently fail to achieve complete eradication. What has to be assessed is not that some is left, but whether what is left explains what is happening to you.
How do I know how much they took out?
By comparison: the imaging from before surgery against the current imaging. And with one honest caveat: there is as yet no standardised measure of how much material is removed, and the authors of the largest published series say so themselves.
I improved, but not completely. Is that normal?
It is the most frequent result. In the available systematic review, 48% achieved a complete response and 50% a partial one.
I do not like how the area looks. Can it be fixed?
Contour irregularity was the most frequent complication in the only comparative study of reconstruction techniques. It is a problem of shape and it is addressed by reconstructing, not by removing more.
How long do I have to wait before considering another operation?
Long enough for the recovery to be complete: the most frequent complication appears at 31 days on average, and the scar goes on changing for months. Judging before then leads to no valid conclusion.
I had surgery in another country and have no report. Is there any point in coming?
Yes, though with more uncertainty. Without a report there is no knowing what was found or what was removed, so we start from scratch with an examination and imaging. Ask for it anyway: it is your clinical record.
Can the same area be operated on twice?
It is assessed, and it depends above all on the state of the tissue, which has already been through surgery and years of chronic reaction. It is neither automatic nor ruled out in advance.
I still have fatigue and general aches after surgery. What does that mean?
Partial improvement in general symptoms is described, and so is their depending on factors other than the material. What is called for is to look at what is left and to rule out other causes, not to assume either of the two.
Sources
- Guan D, Yuan H, Sun K, Zheng Y, Ju S, Xia W. Clinical Experience in the Management of the Polyacrylamide Hydrogel (PAAG) Associated Complications Including Four Breast Cancer Cases: A Retrospective Study of 135 Cases. Aesthetic Plast Surg. 2025;49:779-787. A retrospective series of 135 patients operated on to remove breast hydrogel; among the post-surgical complications, residual material in 17.0%, skin laxity 7.4%, haemorrhage 2.2%, reoperation 1.5% and nipple or breast asymmetry 1.5%. Level of evidence IV. https://pubmed.ncbi.nlm.nih.gov/39317860/
- Li T, Zhu Z, Feng Y, Du Z. Endoscopic-assisted removal of injectable Amazingel with or without immediate prepectoral implant-based breast augmentation: safety and aesthetic outcomes from a retrospective study. Gland Surg. 2026;15:73. The authors note that conventional removal techniques are frequently insufficient to achieve complete eradication, giving rise to persistent complications and suboptimal aesthetic results; in their series of 42 patients, minimal residue was detected on imaging in two (4.76%) with no associated discomfort. https://pubmed.ncbi.nlm.nih.gov/41969934/
- Mustin DE, Barrett DL, Gangal A, White MS, Yeung H. Management of silicone granuloma: A systematic review. JAAD Int. 2023;11. Ninety-three studies with 227 participants; surgical excision accounted for 66.2% of treatments, with 48% complete and 50% partial responses; the evidence is limited to case series and a single cohort study. https://pubmed.ncbi.nlm.nih.gov/36865613/
- Osorio E, Ramírez B, Herrera O, Suarez C, Ciro C, Varela A. Three-flap Technique: Comprehensive Approach for Biopolymer Removal in the Gluteal and Lumbar Regions. Plast Reconstr Surg Glob Open. 2026;14:e7870. A retrospective cohort of 199 patients; dehiscence in 21.1% and tissue necrosis in 3.5%; the authors conclude that further studies are needed to quantify the material removed and to compare the results with alternative techniques. https://pubmed.ncbi.nlm.nih.gov/42495057/
- Ghoraba SM. The Outcome of 3 Various Reconstructive Procedures After Permanent Filler Removal and Deep Plane Face Lift. Plast Reconstr Surg Glob Open. 2026;14:e7367. A randomised multi-arm study with three groups of 160 patients according to the method of reconstructing the defect after removal of permanent filler; the most prevalent complication in all three groups was contour irregularity. https://pubmed.ncbi.nlm.nih.gov/41858711/
- Eusse Llanos JC, Posada López S. Paramedian open approach for gluteal biopolymers removal: a case series of 35 patients. JPRAS Open. 2025;45. A series of 35 patients; the most frequent complication was seroma (40%), with a mean time to formation of 31 days, followed by wound dehiscence and infection. https://pubmed.ncbi.nlm.nih.gov/40837208/
Book your consultation
If you have had surgery and are still unwell, what orders the situation is not one more opinion: it is knowing what is left, where it is and whether that explains what you feel. For that, three things are needed — the surgical report, the imaging from before and an image from now — and with them the conversation changes completely.
If you do not have all of them, come anyway: we start with whatever there is.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
