BACKGROUND: Complications often arose after polyacrylamide hydrogel (PAAG) injections for breast augmentation. This study aimed to explore the complications and clinical management of breast augmentation with PAAG. METHODS: We retrospectively analyzed the data of 135 patients who underwent breast PAAG removal from January 2011 to December 2023 in our hospital. We also comprehensively analyzed the postoperative clinical results, subsequent complications, and clinical management after PAAG injections. RESULTS: Induration and nodules (60.0%), pain (27.4%), anxiety (22.2%), migration (13.3%), asymmetry (8.1%), swelling (5.9%), infection (5.2%), calcification (3.7%), and breast cancer (BC) (3.0%) were a few complications after PAAG injections. Although breast cancer was a rare complication, it might be covered up by PAAG tissue. Eighty-eight patients had undergone PAAG removal, while 47 patients had additional breast reconstruction surgery. The post-surgical complications included PAAG residue (17.0%), skin laxity (7.4%), hemorrhage (2.2%), reoperation (1.5%), and nipple or breast asymmetry (1.5%). Additionally, the BREAST-Q scores revealed that patients with breast reconstruction had a significant better outcomes in psychosocial well-being (p <
0.001), satisfaction with breasts (p <
0.001), and sexual well-being (p = 0.008). CONCLUSION: Multiple complications could occur after PAAG injections for breast augmentation. Although rare, BC might need more clinical attention. PAAG removal could alleviate some complications, and breast reconstruction contributed to improved patient satisfaction, psychosocial well-being, and sexual well-being. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.