Photo/Illutration(The Asahi Shimbun)

A plastic surgery association is seeking to ban the “filler-injection” method for breast augmentation following multiple reports of complications, including deformities and infections, in Japan’s totally unregulated field.

“We should stop using filler for the purpose of breast augmentation,” said Hiroyuki Ojimi, an executive of the Japan Society of Aesthetic Plastic Surgery (JSAPS).

JSAPS, which has 1,220 members, plans to compile guidelines within a year to prohibit medical doctors from using filler for breast enhancement and to set other regulations. It will ask the health ministry to create an approval system for the breast augmentation sector.

Filler gel, comprising several chemical agents, including polyacrylamide, silicon and hyaluronic acid, is injected into the breast through a tube.

The method is popular among Japanese women because, unlike implants of silicon-packed artificial breasts, it does not require general anesthesia nor leave large scars.

However, 72 of 132 plastic surgeons who responded to a JSAPS survey reported a total of 108 cases of complications among patients who underwent the filler method.

According to the survey, 44 percent of the cases involved lumps or clots, 22 percent concerned infection diseases, 8 percent were changes in skin conditions, and 6 percent involved deformations.

The survey was sent to around 4,000 plastic surgeons in June and July.

Shunichi Nomoto, a doctor at Nippon Medical School Hospital, said he has seen patients experiencing such difficulties following breast augmentation treatments.

Nomoto said under the filler method, the gel is supposed to be injected into the gap between two fasciae layers, one that covers the greater pectoral muscle and the other on the lacteal gland side.

But inflammation can occur if germs enter the body during the process or if the filler is accidentally inserted into the lacteal gland.

Silicone-packed artificial breasts can be easily removed as a mass. But it is very difficult to completely remove filler, especially if it has spread to the lacteal gland or greater pectoral muscle.

Another association, the 975-member Japan Society of Aesthetic Surgery, issued a statement in March 2017, saying it could not recommend breast augmentation treatment that uses some types of filler.

The U.S. Food and Drug Administration prohibits medical doctors from using filler for breast augmentation because the agents can clog blood vessels.

But in Japan, the government has not approved any type of filler for breast augmentation, and the amount of filler that is marketed is unknown.

The filler method is not covered by public health insurance, and doctors are not subject to regulations in the country.

“Our patients are more satisfied with the filler treatment, which makes their breasts softer than those with silicone-packed artificial breasts,” said a doctor at a hospital in Tokyo. “Patients who suffered from health problems must have been treated by low-skilled doctors.”

According to JSAPS, about 11,000 breast augmentation operations for cosmetic purposes are conducted annually in Japan, with the filler method accounting for 80 percent of them.

The filler method started in the 1950s in Japan, using gel-formed silicone and other materials.

But diseases caused by immunity mechanism problems, including the scleroderma skin ailment, were reported. The materials were replaced with other agents, and many of the products are now imported from overseas.

This has led some people to describe Japan as “an experiment field” in breast augmentation.

The government has approved some filler types to remove facial wrinkles. But the amount used is limited to only about 2 to 3 milliliters in total, even for more than one part of a face.

For breast augmentations, about 200 milliliters of filler is often injected for just one breast.

JSAPS warns that complications are more likely to occur with larger injections of filler.

The association urges patients who encounter problems after such treatments to see plastic surgeons at university hospitals or general clinics.

The costs for medical care for health damages caused by the filler method are not covered by public health insurance.

(This article was jointly written by journalists whose organizations are members of the International Consortium of Investigative Journalists. They include Asahi Shimbun reporters Kenji Tamura, a senior staff writer, Kohei Tomida and Mizuho Kajiwara, as well as journalists from Kyodo News and Japan Broadcasting Corp.)