Breast implant rupture may lead to intracapsular or extracapsular contiguous spread of the free silicone. This is a problem that is quite common and may lead to disruption of implant integrity, but more importantly, functional and cosmetic changes in the breast and soft tissue. This case report demonstrates a unique presentation characterized by hematogenous or lymphatic spread of th free silicone beyond the confines of the breast. 

 

The case report describes a woman in her 40’s who developed asymmetric breast changes, palpable lymph nodes in the axilla, and cutaneous nodules in the upper extremities. Notable medical history included a cosmetic breast augmentation a few years prior. Biopsy of the cutaneous nodules demonstrated a chronic granulomatous reaction notable for foreign-body giant cells related to silicone. 

 

Diagnostic studies demonstrated intracapsular breast implant rupture and internal mammary lymph nodes as well as mediastinal lymph nodes. 

 

Removal of the breast implants demonstrated a ruptured shell and led to longterm improvement of the lymphadenopathy as well as resolution of the cutaneous nodules. The authors suggest that these complications resulted from lymphatic or hematogenous spread of the silicone. 

 

This case report illustrates the wide spectrum of diseases that can arise from free silicone. In our offices in Los Angeles and Beirut, we manage many different complications associaed with silicone disease. Free liquid silicone can arise from a ruptured silicone breast implant or from direct infiltration of silicone into the body. In either case, the identified silicone should be removed. It is not readily clear why the silicone cutaneous nodules cleared in this case report - as the removal of the silicone breast implants did not necessarily remove the distant spread of the silicone plastic. 

 

Keywords: Breast silicone, radiology, mammogram, Breast implant rupture, free silicone, siliconomas, karamanoukian

 

Raffy Karamanoukian  MD FACS

Los Angeles

www.karesurgery.com 

Plastic Surgery - Removal of Breast Implant Rupture and Free Silicone at Kare Plastic Surgery