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BACKGROUND: Adverse reactions to polyacrylamide gel occur as swellings or nodules, and controversy exists whether these are due to bacterial infection or an autoimmune reaction to the filler. OBJECTIVES: Biopsies from culture-negative long-lasting nodules after injection with different types of polyacrylamide gel were examined with a combination of Gram stain and fluorescence in situ hybridization. RESULTS: Bacteria were detected in biopsies from seven of eight patients. They inhabited gel and intervening tissue and tended to lie in aggregates. CONCLUSION: This study supports the assumption that infection with bacteria in aggregates causes culture-negative late adverse reactions to polyacrylamide gel, suggesting a biofilm environment.
Bjarnsholt et al. (Wed,) studied this question.