Leakage and silicone lymphadenopathy with cohesive breast implant

A Case of Silicone and Sarcoid Granulomas in a Patient with "Highly Cohesive" Silicone Breast Implants: A Histopathologic and Laser Raman Microprobe Analysis

Foreign body giant cell (FBGC) reaction to silicone material in the lymph nodes of patients with silicone breast implants has been documented in the literature, with a number of case reports dating back to 1978. Many of these case reports describe histologic features of silicone lymphadenopathy in regional lymph nodes from patients with multiple sets of different types of implants, including single lumen smooth surface gel, single lumen textured surface gel, single lumen with polyethylene terephthalate patch, single lumen with polyurethane coating, and double lumen smooth surface. Only one other case report described a patient with highly-cohesive breast implants and silicone granulomas of the skin. In this article, we describe a patient with a clinical presentation of systemic sarcoidosis following highly cohesive breast implant placement. Histopathologic analysis and Confocal Laser Raman Microprobe (CLRM) examination were used to confirm the presence of silicone in the axillary lymph node and capsular tissues. This is the first report where chemical spectroscopic mapping has been used to establish and identify the coexistence of Schaumann bodies, consisting of calcium oxalate and calcium phosphate minerals, together with silicone implant material.

Silicone lymphadenopathy: presentation of a further case containing asteroid bodies on fine-needle cytology sample

Silicone lymphadenopathy is a recognized complication of breast augmentation. It is thought to occur when silicone droplets migrate from breast implants to lymph nodes. We report the cytologic findings in axillary and inguinal lymph node aspirate smears from a 35-year-old Italian woman, who came to our observation 10 years after bilateral cosmetic breast augmentation. A fine-needle cytology of the axillary lymph node showed extensive granulomatous inflammation, numerous histiocytes, and multinucleated giant cells containing star-shaped structures known as "asteroid bodies." The inguinal lymph node aspirate simply showed an aspecific reactive hyperplasia. No evidence of malignancy was present in any of the smears as well as in the excised axillary lymph node.

PIP silicone breast implants: rupture rates based on the explantation of 676 implants in a single surgeon series

INTRODUCTION

To determine the true rupture rates of PIP implants from a large single surgeon cohort and to assess whether rupture rates varied depending on time of implant insertion. In addition, the efficacy of ultra sound scanning (USS) in determining rupture is examined.

DESIGN

Predominantly prospectively based analysis of patient records, investigations and surgical findings.

PARTICIPANTS

338 patients (676 implants) were included in the study and they all had removal of their implants. The senior author operated on all patients at some stage of their treatment. 160 patients were imaged pre-operatively with USS. Patients had implants inserted between 1999 and 2007 for cosmetic breast augmentation.

RESULTS

A total of 144 ruptured implants were removed from 119 patients, giving a rupture rate of 35.2% per patient and 21.3% per implant over a mean implantation period of 7.8 years. A statistical difference (P < 0.001) in rupture rates between implants inserted prior to 2003 and those inserted from 2003 was demonstrated, with higher failure rates in the latter group. There was a significant difference in rupture rates depending on pocket placement of the implants. The sensitivity and specificity of USS at detecting rupture was 90.6% and 98.3% respectively. A proportion of patients (29.4%) demonstrated loco-regional spread of silicone to the axilla on scanning.

CONCLUSIONS

Our paper has confirmed high rates of PIP implant failure in the largest published series to date. The significant difference in rupture rates between implants inserted prior to 2003 and those after this time supports the view that industrial silicone was used in the devices after 2003. Implants are more likely to rupture if inserted in the sub muscular plane compared to the sub glandular plane. USS is highly effective at detecting rupture in PIP implants and loco-regional spread is high compared to other devices. We believe this paper provides hard data enabling more informed decision making for patients, clinicians and providers in what remains an active issue affecting thousands of women.

Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts

BACKGROUND

Silicone lymphadenopathy after implantation of silicone breast implants is a foreign body reaction due to the release or migration of silicone into the tissues surrounding the breast implant.

METHODS

For the study, 14 cases of silicone lymphadenopathy were identified from the authors' files. Four patients had been implanted before 2000 and had various types of implants. The remaining 10 patients all were implanted between 2006 and 2009, and all had Poly Implant Prothèse (PIP) implants. In addition to an analysis of the authors' own cases, a thorough bibliographic search was initiated to identify all reports of lymphadenopathy related to silicone breast implants.

RESULTS

The implant age of the four patients implanted before 2000 was 12-34 years (mean, 17.25 years). The implant age of the 10 patients implanted after 2000 was 2-6 years (mean 3.45 years). The literature search identified 29 papers with case reports of silicone lymphadenopathy published between 1978 and 2012, with a total of 175 cases. Usable data were extracted from 164 of the 175 cases. Of these patients, 159 were implanted before (and including) the year 2000 and had a mean age of 11 years at presentation or explantation, and 5 of these patients were implanted after the year 2000 and had a mean age of 4.6 years at presentation or explantation . After inclusion of the authors' own cases, the mean age of the implants at presentation or explantation was 10.56 years in a total of 178 cases. Of these patients, 163 were implanted before (and including) the year 2000 and had a mean age of 11.16 years at presentation or explantation, and 15 of these patients were implanted after the year 2000 and had a mean age of 4.06 years at presentation or explantation.

CONCLUSIONS

Current breast implant technology has minimized the release of silicone gel due to rupture or bleeding of silicone and its migration into the surrounding tissues, thus reducing the rate of silicone lymphadenopathy in the last 10 years. The PIP implant scandal highlights the fact that disregard for the implant manufacturing technologies and standards in favor of higher profits increased rupture rates and gel diffusion, leading to increased local complication rates. Silicone lymphadenopathy is a foreign body reaction that does not warrant treatment unless it is symptomatic or interferes with breast cancer detection.

LEVEL OF EVIDENCE III

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Axillary silicone lymphadenopathy secondary to augmentation mammaplasty

We report a case involving a 45-year-old woman, who presented with an axillary mass 10 years after bilateral cosmetic augmentation mammaplasty. A lump was detected in the left axilla, and subsequent mammography and magnetic resonance imaging demonstrated intracapsular rupture of the left breast prosthesis. An excisional biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Histological analysis showed that the axillary lump was lymph nodes containing large amounts of silicone. Silicone lymphadenopathy is an obscure complication of procedures involving the use of silicone. It is thought to occur following the transit of silicone droplets from breast implants to lymph nodes by macrophages and should always be considered as a differential diagnosis in patients in whom silicone prostheses are present.

Axillary silicone lymphadenopathy presenting with a lump and altered sensation in the breast: a case report

Introduction

Silicone lymphadenopathy is a rare but recognised complication of procedures involving the use of silicone. It has a poorly understood mechanism but is thought to occur following the transportation of silicone particles from silicone-containing prostheses to lymph nodes by macrophages.

Case presentation

We report of a case involving a 35-year-old woman who presented to the breast clinic with a breast lump and altered sensation below her left nipple 5 years after bilateral cosmetic breast augmentations. A small lump was detected inferior to the nipple but clinical examination and initial ultrasound investigation showed both implants to be intact. However, mammography and magnetic resonance imaging of both breasts revealed both intracapsular and extracapsular rupture of the left breast prosthesis. The patient went on to develop a flu-like illness and tender lumps in the left axilla and right mastoid regions. An excision biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Subsequent histological analysis showed that the axillary lump was a lymph node containing large amounts of silicone.

Conclusion

The exclusion of malignancy remains the priority when dealing with lumps in the breast or axilla. Silicone lymphadenopathy should however be considered as a differential diagnosis in patients in whom silicone prostheses are present.

Left unilateral breast autoinflation and intraprosthetic collection of sterile pus: an unusual operative finding of silicone gel bleed with silicone lymphadenitis

Implant rupture is a known complication after augmentation mammoplasty. Saline implant failure may present with few diagnosable problems due to the loss of volume. On the other hand, intracapsular silicone gel implant rupture or failure can be silent, asymptomatic, and difficult to diagnose in the absence of loss of breast volume. Silicone leak and migration to regional nodes has been reported but is uncommon and lymph node enlargement can be nonspecific in patients with intact prostheses. Causes, timing, and diagnosis of implant failure sites and mechanisms have been extensively studied and reported in the literature. Implant failure resulting in lymphadenopathy is uncommon. In this article autoinflation of the left breast with regional lymphadenopathy is presented. Upon exploration, the prosthesis was found to be filled with sterile pus, showing an inward movement of a thick creamy material in an otherwise macroscopically intact prosthesis.

Incidental Findings in Negative Sentinel Lymph Nodes of Patients With Malignant Melanoma: Report of Three Cases

We present three cases of benign SLN that were clinically suspicious for involvement by metastatic melanoma and where found to be involved with other diseases or deposits previously unknown.

The Diagnosis of Silicone Breast-Implant Rupture

The objective was to evaluate the usefulness of clinical examination in the evaluation of breast-implant integrity, using the diagnosis at magnetic resonance imaging (MRI) as the "gold standard." Fifty-five women with 109 implants underwent a breast examination either just before or shortly after an MRI examination. Twenty-four of 109 implants were clinically diagnosed with possible rupture or rupture. Eighteen of the 24 implants were ruptured according to the MRI examination (75%). Eighty-five implants were clinically classified as intact, and 43 of these were actually ruptured at MRI (51%). The sensitivity of the clinical examination for diagnosing rupture was thus 30% and the specificity 88%. The positive predictive value of a clinical diagnosis of rupture was 75%, and the negative predictive value was 49%. In this study, we found that when a clinical examination is used as the sole diagnostic tool to identify implant rupture, neither the sensitivity nor the specificity is acceptable.