Shame, guilt and mental health when you have biopolymers

There is a part of this problem that comes up in no consultation because nobody asks about it: what it weighs on the inside.

The guilt at having had it done. The shame of saying so. Giving up the beach, giving up being photographed, giving up undressing in front of anyone. The very common feeling that if anything goes wrong you brought it on yourself.

This page exists because that is not a subjective impression: it has been measured. And because what is done about it changes the medical result, not just the mood.

The process is in the guide to biopolymer removal and the decision whether to operate, in remove or monitor.

What has been measured

It is worth putting the figures before any reassurance, because a figure does something reassurance cannot: it validates what you feel in front of anyone, yourself included.

Anxiety is one of the most frequent consequences. In the series of 135 patients operated on to remove breast hydrogel, among the complications recorded after injection anxiety appeared in 22.2% of cases. Ahead of migration of the material (13.3%), asymmetry (8.1%) and infection (5.2%). It is not a minor side effect: it is the third most frequent after induration and pain.

And it falls when the material is removed. In the cohort of 199 patients operated on for gluteal and lumbar removal, anxiety was one of the three symptoms with a statistically significant reduction after surgery, along with muscle pain and fatigue. Sleep quality and how often they exercised also improved.

For the face it has been measured in more detail. In a series of 160 patients operated on for complications from permanent filler, the psychological outcomes improved significantly: more self-esteem, more social interaction, less anxiety and fewer depressive symptoms.

And reconstruction matters. Among the 135 patients in the breast series, those who underwent reconstruction as well as removal scored significantly better on psychosocial well-being, satisfaction with their breasts and sexual well-being than those who only had the material removed. The shape was not a whim: it was part of the result.

Shame has a cost, and it is a clinical one

This is the point that may be most useful to you today.

A 40-year-old woman was admitted with a very high blood calcium level. A year earlier, that same abnormality had been put down to her kidney disease and her medication. It was investigated, causes were ruled out, and a label was applied that was not the right one.

The diagnosis came when she said she had been injected with silicone. With that one fact, everything fitted: the chronic reaction to the material explained the calcium abnormality. It was treated and it resolved.

A year of detour for a sentence that was not said.

And the reason it does not get said is almost always the same: fear of the face on the other side of the desk. Of being looked at differently, of being thought reckless, of having to justify why you had it done.

It is worth saying plainly: that judgement, as well as being useless, is usually unfair. The most-cited population study on the use of illicit fillers concludes that turning to them may be the only option available for many people, because of the cost of surgery and of legal procedures. It is a problem of access. Not of character.

What surgery does and what it does not

It is worth separating, because the confusion does harm in both directions.

What it does: removing the material and the reactive tissue improves physical symptoms, and with them improve psychological measures that have been quantified — anxiety, self-esteem, social interaction, sleep. Ceasing to be in pain or to hide a part of your body has a real effect on how you live.

What it does not:

• It does not erase what happened. The material is removed; the experience of having carried it for years is not.
• It does not give you back your previous body. That starting point no longer exists, and that is in what results to expect.
• It is not a treatment for anxiety or depression. If there is an established mental health problem, it has its own approach and its own professional.
• It does not fix a mismatched expectation. In one of the series cited, having unrealistic expectations was an exclusion criterion for surgery. It is not an arbitrary barrier: an impossible expectation guarantees an unsatisfactory result however good the result is.

What helps

Without magic formulas and without promising anything:

• Saying it once, to a professional. That breaks the cycle. What you were given, where and since when is enough.
• Knowing what you have. A good part of the anxiety in this problem is uncertainty: not knowing how much there is, where it is or whether it is getting worse. An imaging scan turns a diffuse fear into a manageable fact, and that alone changes how it is lived with. It is in the diagnosis page.
• Knowing that monitoring is a legitimate option. Many people live with a sense of “failing” by not having surgery. That is not so, and there is a protocol for it.
• Psychological support if it is needed. Not as a substitute for the medical solution, but as what it is: a treatment in its own right for a problem in its own right.
• And not accepting other people’s judgement as part of the diagnosis. Whoever treats you needs to know what you have. They do not need to have a view on why.

What you will not find here, said plainly

At the Instituto de Cirugía Plástica del Mediterráneo there is no psychologist and no referral pathway to psychology. We say so because it is useful information: if what you need right now is psychological support, this practice is not where you are going to get it, and knowing that saves you a wait.

What you can expect here is a medical assessment in which nobody is going to ask you why you had it done, and honest guidance on what surgery can and cannot change. If it becomes clear at that consultation that the emotional weight is shaping the decision — in either direction, to operate or not to operate — we say so and recommend seeking that support through the right route: your GP, who is the way into mental health services in the public system, or a private professional. None of that is something we treat.

Frequently asked questions

Is it normal to feel ashamed about this?

It is so frequent that it has measurable consequences: there is a published case in which not mentioning it delayed the correct diagnosis of a calcium abnormality by a year. The shame is understandable; the price of keeping quiet is paid by you.

I feel guilty for having had it done. Does that make sense?

It is a very common feeling and it does nothing at all for the medical problem. The benchmark population study on this subject concludes that turning to these products may be the only option available to many people because of the cost of the legal alternatives.

Will my anxiety go if I have surgery?

It is described as improving: in a series of 199 patients, anxiety fell significantly after removal, and in another of 160 facial patients self-esteem and social interaction improved. It is not an individual guarantee, and it does not replace mental health treatment if there is an established problem.

Will I be judged at the consultation?

It should not happen, and in any case whoever treats you needs the information to do their job properly. If you come out of a consultation feeling judged, that says something about that consultation, not about you.

I have no symptoms but I find it hard. Does that count?

It counts, and it is in the figures: anxiety is listed as one of the most frequent consequences recorded, ahead of physical complications. That it does not hurt does not mean it does not weigh.

Is reconstruction a luxury?

The figures say not. Patients who had their breasts reconstructed after removal scored significantly better on psychosocial well-being, satisfaction and sexual well-being than those who only had the material removed.

And if my expectation is to go back to how I was before?

That particular expectation cannot be met, and it is worth discussing before surgery. In one of the published series, unrealistic expectations were an exclusion criterion, precisely because they shape satisfaction with any result.

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 between 2011 and 2023; among the complications recorded after injection, anxiety in 22.2%, behind induration and nodules (60.0%) and pain (27.4%) and ahead of migration (13.3%), asymmetry (8.1%) and infection (5.2%); BREAST-Q scores were significantly better in patients who also had breast reconstruction for psychosocial well-being (p < 0.001), satisfaction with the breast (p < 0.001) and sexual well-being (p = 0.008). Level of evidence IV. https://pubmed.ncbi.nlm.nih.gov/39317860/
• 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; statistically significant reductions in myalgia (OR 0.15), asthenia (OR 0.03) and anxiety (OR 0.08) after surgery, with improvements in sleep quality and exercise frequency as well. https://pubmed.ncbi.nlm.nih.gov/42495057/
• Ghoraba S, Loucas M, Loucas R. Management of Permanent Filler Complications Using Deep-Plane Facelift and Temporoparietal Fascial Flap Reconstruction: A Retrospective Study. Aesthet Surg J Open Forum. 2025;7:ojaf106. A retrospective study of 160 patients operated on between 2014 and 2022; the psychological outcomes improved significantly, with higher self-esteem and social interaction scores and reduced anxiety and depression levels; unrealistic expectations were among the exclusion criteria. https://pubmed.ncbi.nlm.nih.gov/41376670/
• Pando BL, Goldsmith B, Webb AL, Kinger K, Helmly B. Free Silicone-Induced Granulomatosis and Hypercalcemia in a Transgender Female. HCA Healthc J Med. 2022;3:161-166. A 40-year-old patient admitted with hypercalcaemia that a year earlier had been attributed to her kidney disease or her medication; the diagnosis was reached when she reported having had free silicone injections, to which the abnormality was attributed, and it resolved with treatment. https://pubmed.ncbi.nlm.nih.gov/37424606/
• Wilson E, Rapues J, Jin H, Raymond HF. The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013. J Sex Med. 2014;11:1717-1724. A population sample of 233 people; weighted prevalence of filler use of 16.7%; the authors note that turning to illicit fillers may be the only option available to many trans women because of the high cost of legal surgery and procedures, and call for safe, affordable alternatives. https://pubmed.ncbi.nlm.nih.gov/24810672/

Book your consultation

If you have gone years without telling anyone, the first step is not theatre: it is saying it once, to a professional, with the areas and the approximate date.

And if what is wearing you down is not knowing what you have inside, that does have a concrete answer and it comes from an assessment.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.