Pregnancy, childbirth, breastfeeding and other special situations with biopolymers

Almost everything written about biopolymers deals with a single question: remove them or not. But in the meantime life goes on, and there are specific moments when carrying injected material changes what has to be done.

This page gathers those moments. The most important, by some way, is childbirth.

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

Pregnancy and childbirth: the epidural

This is the section this page exists for.

What can happen

Permanent fillers migrate along tissue planes, and in the case of the buttocks that migration can go upwards, into the soft tissues of the lumbar region. It is a described phenomenon, not a hypothesis.

And there lies the problem: the lumbar region is exactly where the needle goes for an epidural or a spinal. The presence of foreign material in that area is considered a relative or absolute contraindication to those techniques, even where there is no radiological evidence that the epidural space is involved.

Translated into what may happen to you in practice: being told you are not a candidate for an epidural, with everything that means for a birth.

Why that is not the end of the story

In 2026 two cases were published pointing the same way, and they are the best news on this page.

The first. A 32-year-old woman, first pregnancy, with migration of gluteal biopolymer confirmed on MRI as far as the L5-S1 level. Instead of ruling the epidural out, the anatomy was studied and it was placed higher up, at L1-L2, under ultrasound guidance, during labour. That same epidural was then used, without incident, for a caesarean.

The second. A pregnant woman with extensive infiltration of permanent silicone in the gluteal and lower lumbar soft tissues, who had previously been deemed not a candidate for epidural analgesia in labour. A radiological reassessment made it possible to identify a safe low thoracic approach, and she was able to have it.

The practical conclusion of both is the same: with prior imaging and planning, neuraxial anaesthesia can be possible. What makes it impossible is almost never the material: it is the lack of time to study it.

What to do, specifically

• Mention it at your first antenatal appointment, not when the contractions start.
• Say where it was injected and how long ago, even if you do not know what it was.
• Ask for it to be considered in good time whether imaging of the lumbar area is needed. That is what allows a decision to be made on data.
• If you have already been told you are not a candidate for an epidural, that can be reassessed. It is literally what happened in the second case.

Breastfeeding

If the material is in the breast, there are two published cases worth knowing about beforehand rather than during.

A 36-year-old woman with polyacrylamide hydrogel injected beneath both breasts developed, on starting to breastfeed, a rapid enlargement of the left breast with unbearable pain. Imaging showed a large fluid collection displacing the glandular tissue, and surgery was needed. It was not possible to remove all the material.

Another patient, with hydrogel injected ten years earlier, attended repeatedly after her two pregnancies with recurrent breast infections, pain and finally massive enlargement of the breast from a ruptured galactocele that required surgery. The authors of that case conclude that, since the safety of hydrogel for the baby is not known, they do not recommend breastfeeding with this material.

How to read it: they are two cases, not a statistic. But they are enough for breastfeeding to be part of the conversation with your team before the birth, rather than of an emergency in the postnatal period. What it means for the breast in general is on the breast page.

Laser, radiofrequency and ultrasound over the area

Here we have to be honest, because it is a frequent question and the sincere answer is uncomfortable: there is no specific evidence.

There are reasonable safety data on combining energy treatments with injectables: a retrospective study of 1,040 patients over 18 years with microfocused ultrasound and monopolar radiofrequency combined with injectables recorded no infections, necrosis, burns or filler migration.

But the small print has to be read: the injectables in that study were neuromodulators, hyaluronic acid and poly-L-lactic acid. That is, resorbable products. There is nothing equivalent published on industrial silicone or on permanent fillers.

So the reasonable course is:

• Always say that you have injected material before any laser, radiofrequency or ultrasound treatment over that area.
• Have a doctor assess whether it makes sense to treat there, and do not assume that what holds for a resorbable filler holds for yours.
• Do not use the absence of evidence as permission or as a prohibition. It means the decision is an individual one and is taken with the information on the table.

Exercise, weight and normal life

There is no useful literature on this, and it is better to say so than to invent it.

What can be stated from what is published:

• There are no data saying that exercise moves the material or that it makes the situation worse.
• There are data in the other direction: in the series of 199 patients operated on for gluteal removal, how often they exercised improved after surgery. What was limiting them was not a prohibition: it was the symptoms.
• The practical criterion, therefore, is the symptoms. If an activity hurts or makes the area swell, that is clinical information and deserves to be raised; if it gives you no trouble, there is no published reason to avoid it.

Other situations where you have to say so

A summary of what other pages in this cluster set out, so as to have it in one place:

The detail on imaging is in the diagnosis page, and that on bone density scans in the page about liquid silicone in trans women, where the study documenting it sits.

Frequently asked questions

I am pregnant and have biopolymers in my buttocks. Will I be able to have an epidural?

You may well be able to, and the key is studying it in good time. The presence of material in the lumbar region is considered a relative or absolute contraindication, but in the two cases published in 2026 radiological assessment made it possible to find a safe level and place the epidural without incident.

I have already been told I am not a candidate for an epidural. Is that final?

Not necessarily. In one of the published cases, a pregnant woman previously deemed not a candidate was able to have epidural analgesia after a radiological reassessment identified a safe approach.

Does pregnancy make biopolymers worse?

There are no data allowing that to be answered generally. What is documented are complications on starting to breastfeed when the material is in the breast.

Can I breastfeed?

With breast hydrogel, the authors of a published case do not recommend it, because its safety for the baby is not known, and there are two cases of serious complications on starting. It is a conversation to have with your team before the birth.

Can I have laser treatment on the area?

Say so beforehand. The safety data on combining energy with injectables are for resorbable fillers, not permanent materials, so they cannot be carried over. The decision has to be taken by a doctor who knows what is underneath.

Can I exercise?

There is no literature advising against it, and in one series exercise frequency improved after the material was removed, which suggests that what limits people is the symptoms. If an activity hurts or makes the area swell, raise it.

And if I have to have surgery for something else?

Say so before the operation, even if the area seems unrelated. The unexpected finding of material during an operation, with the need to adapt the surgical plan in the same session, has been described.

I am having a bone density scan — does it affect it?

If you have industrial silicone in your buttocks, it can: hip bone density comes out falsely high. Assessing the spine and forearm is recommended.

Sources

• Mullins H, Spence NZ, Achu-Lopes R. Neuraxial Anesthesia in a Parturient With Migrated Gluteal Biopolymer: A Case Report. A A Pract. 2026;20:e02196. Gluteal biopolymer injections can migrate unpredictably to the lumbosacral region, creating potential barriers to neuraxial anaesthesia and a risk of contaminating neuraxial structures; a case of a 32-year-old first-time mother with migration confirmed on MRI as far as L5-S1, in whom an epidural was placed at L1-L2 under ultrasound guidance during labour and then used without incident for the caesarean; the authors conclude that neuraxial anaesthesia can be feasible when imaging is used to identify safe puncture points, and stress the importance of prior planning. https://pubmed.ncbi.nlm.nih.gov/42024805/
• Foggi Viligiardi T, Matteoni C, Bitossi U, Micaglio M. Thoracolumbar labour epidural analgesia in a parturient with permanent gluteal silicone-like biopolymer infiltration. Anaesth Rep. 2026;14:e70060. Permanent fillers can migrate along fascial planes and induce chronic inflammation, fibrosis and a granulomatous reaction years after injection; the presence of foreign material in the lumbar region is considered a relative or absolute contraindication to epidural or spinal techniques, even without radiological evidence of involvement of the epidural space; in the case described, a pregnant woman with extensive infiltration of permanent silicone in the gluteal and lower lumbar soft tissues, previously deemed not a candidate for neuraxial analgesia, was able to receive it after a radiological reassessment identified a safe low thoracic approach. https://pubmed.ncbi.nlm.nih.gov/41971678/
• Ebisudani S, Inagawa K, Suzuki Y, Osugi I. Unilateral Breast Inflation Caused by Breastfeeding after Polyacrylamide Hydrogel Injection. Plast Reconstr Surg Glob Open. 2021;9:e3335. A 36-year-old woman with polyacrylamide hydrogel injected beneath both mammary glands who, on starting to breastfeed after the birth, developed rapid enlargement of the left breast with unbearable pain; CT showed marked fluid retention with displacement of the glandular tissue and abundant fluid was drained at surgery; complete removal of the material was not possible. https://pubmed.ncbi.nlm.nih.gov/33552807/
• Bourke AG, Jose C. Recurrent complications of PAAG implants during lactation. BMJ Case Rep. 2018. A 35-year-old woman with polyacrylamide hydrogel injected ten years earlier who attended on numerous occasions after her two pregnancies with recurrent bilateral breast infection, pain and finally massive breast enlargement from a ruptured galactocele requiring surgery; since the safety of hydrogel for the baby is not known, the authors do not recommend breastfeeding with this material. https://pubmed.ncbi.nlm.nih.gov/30396888/
• Suh DH, Chen LC, Chung HJ, Lee SJ, Kim J. An 18-year comprehensive safety study on microfocused ultrasound and monopolar radiofrequency combined with cosmetic injectables in 1,040 patients. Arch Dermatol Res. 2025;317:251. A retrospective review of 1,040 patients treated between 2005 and 2023 with microfocused ultrasound or monopolar radiofrequency combined with injectables — neuromodulators (76.9%), hyaluronic acid (17.3%) or poly-L-lactic acid (5.8%); the adverse effects recorded were few and no infections, necrosis, burns, filler migration or unexpected premature loss of filler were reported. The injectables studied are resorbable; the work does not include permanent fillers or industrial silicone. https://pubmed.ncbi.nlm.nih.gov/39821337/
• 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; after removal, well-being indicators such as sleep quality and exercise frequency improved. https://pubmed.ncbi.nlm.nih.gov/42495057/
• Fighera TM, da Silva ED, Borba GDS, Spritzer PM. Does (mis)use of industrial liquid silicone implants interfere with bone mineral density in transgender women?. Arch Osteoporos. 2020;15:149. In trans women with gluteal industrial silicone, bone mineral density was significantly higher at the femoral neck and total femur, with no differences at the lumbar spine or forearm; the authors conclude that the finding may be artefactual and suggest using the spine and forearm for a more accurate assessment. https://pubmed.ncbi.nlm.nih.gov/32964330/
• Moris V. Intraoperative Discovery of Permanent Gluteal Filler During Implant Revision: A Case Report on Surgical Adaptation and Risk Awareness. Am J Case Rep. 2026;27:e950406. Unexpected intraoperative finding of gelatinous material consistent with permanent filler during revision of a gluteal augmentation, which forced the procedure to be adapted in the same session and the planned fat grafting to be abandoned. https://pubmed.ncbi.nlm.nih.gov/41787771/

Book your consultation

If you are pregnant or planning to be and you have injected material, the urgent thing is not surgery: it is that your obstetric and anaesthetic team know in good time, so that the lumbar area can be studied before the birth and not on the day.

And if what you have is a question about a treatment, a test or a specific activity, that conversation fits into 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.