Journal of Asia Pacific Aesthetic Sciences

Abstract: Breast augmentation procedures have evolved significantly, shifting from invasive to minimally invasive approaches. Injectable fillers are among the preferred options due to their less invasive nature; however, their safety and legality remain controversial and vary by region. In Malaysia, the use of breast fillers has increased, yet the true incidence and complications are underreported due to inadequate regulation. This case involves a 50-year-old woman who developed recurrent breast abscesses in 2020 following a filler injection performed by an uncredentialed beautician. Despite multiple incision and drainage procedures and prolonged antibiotic therapy, she continued to experience abscess recurrence with significant breast tissue distortion. Culture results revealed Pseudomonas aeruginosa and MRSA infections, leading to prolonged hospitalization and discussions regarding bilateral mastectomy. Conservative management was continued after multidisciplinary evaluation. Serial MRI follow-up up to October 2024 demonstrated persistent injection granulomas and post-surgical fibrosis without new abscess formation. This case underscores the severe and long-term complications that can result from unregulated breast filler use, emphasizing the importance of patient education, strict procedural regulation, and multidisciplinary management in preventing morbidity and unnecessary surgical interventions such as mastectomy.