Chronic Pulmonary Silicone Embolism from Breast Augmentation Is Not a Common Finding in Explanted Lungs

Silicone Migration From Breast Implants: A Case of Ocular Siliconoma and Literature Review

BACKGROUND

Breast augmentation with implants is one of the most popular cosmetic surgery operations performed worldwide. Complications of breast implants are well recognized, and include capsular contracture, implant rupture, and infrequently distant migration of silicone, resulting in siliconoma. Distant migration of silicone can present many years after implantation with a wide variety of signs and symptoms.

OBJECTIVES

The aim of this study was to describe the authors' experience of orbital silicone migration and to review the literature describing documented cases of distant silicon migration from breast implants, both ocular and nonocular.

METHODS

In January 2022, a case of breast implant augmentation presented with silicone migration into the right orbit. This rare case was monitored and diagnosed with ocular muscle palsy and diplopia. Here, the authors present the patient's presenting complaint, symptomatology, working investigations, and outcomes. A comprehensive report of all available cases of distant silicone migration is presented along with their associated complications and more specifically ocular silicone migration.

RESULTS

Systemic migration of silicone from breast implants to the orbital region is extremely rare: a total of 4 previous cases of ocular silicone migration from breast implants have been described previously; the authors describe the fifth case herein.

CONCLUSIONS

Silicone implant rupture can present with a wide variety of clinical symptoms that may mimic different clinical pathologies. In every patient with a history of breast augmentation with silicone implants, the possibility of silicone migration should be always taken into consideration during the differential diagnosis process.

LEVEL OF EVIDENCE: 5

Acute respiratory distress syndrome following breast augmentation managed by delayed veno-venous extracorporeal membrane oxygenation

The initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been opposed in late-phase acute respiratory distress syndrome (ARDS) due to an increase in mortality. Herewith an individual case of a 20-year-old female who survived severe ARDS after breast augmentation is reported, whose delayed transfer to our tertiary referral center led to a late initiation of VV-ECMO and multiple mechanical ventilation-associated complications. Nonetheless, her VV-ECMO was decannulated after 45 days of ARDS onset, considering an awake ECMO strategy possibly contributing to her positive outcome. We also provided spirometry results and chest radiography findings over the three years of follow-up. Intensive care specialists need to consider the potential use of ECMO in late-phase ARDS with selected patients.

The extended effect of adsorbed damage-associated molecular patterns and Toll-like receptor 2 signaling on macrophage-material interactions

Implanted biomaterials elicit an immune-mediated foreign body reaction (FBR) that results in the fibrous encapsulation of the implant and can critically impact the performance of some implants. Consequently, understanding the molecular mechanisms that underpin cell-materials interactions that initiate biomaterial-induced inflammation and fibrosis is critical to improving the performance of biomaterial implants negatively impacted by the FBR. Damage-associated molecular patterns (DAMPs) are endogenous mediators of inflammation that are released upon tissue injury and induce sterile inflammation via Toll-like receptors (TLRs). However, the prevalence of DAMPs within the adsorbed protein layer on material surfaces and their role mediating cell-material interactions is unclear. Previously, our group demonstrated that molecules in fibroblast lysates adsorbed to various biomaterials and induced a potent TLR2-dependent inflammatory response in macrophages at 24 h. In this study, we examined the extended response of RAW-Blue reporter macrophages on lysate or serum-adsorbed Teflon™ AF surfaces to understand the potential role of adsorbed DAMPs in macrophage-material interactions at later time points. Lysate-conditioned surfaces maintained increased nuclear factor kappa B (NF-κB) and activator protein 1 (AP-1) transcription factor activity and increased expression Regulated upon Activation, Normal T Cell Expressed and Presumably Secreted (RANTES/CCL5) at 72 h and 120 h, compared to FBS-conditioned surfaces. In contrast, monocyte chemoattractant protein 1 (MCP-1/CCL2) was only elevated at 72 h in lysate conditions. Transforming growth factor beta 1 (TGF-β1) secretion was significantly increased on lysate-conditioned surfaces, while conditioned media from macrophages on lysate-conditioned surfaces induced alpha smooth muscle actin (αSMA) expression in 3T3 fibroblasts. TLR2 neutralizing antibody treatment significantly decreased NF-κB/AP-1 activity and attenuated TGF-β1 expression at both time points, and MCP-1 and RANTES at 72 h. Finally, multinucleated cells were observed on lysate-conditioned surfaces at 72 h, indicating adsorbed DAMPs induced a fusion permissive environment for adherent macrophages. This study demonstrates that adsorbed DAMPs continue to influence macrophage-material responses beyond the initial 24-h period and maintain a pro-inflammatory and fibrotic response that models aspects of the early FBR. Furthermore, the transient inhibition of TLR2 continued to exert an effect at these later time points, suggesting TLR2 may be a target for therapeutic interventions in FBR.

Breast Implants on Computed Tomography—A Pictorial Review of Normal and Pathologic Findings

Breast augmentation with implants is frequently performed. Therefore breast implants can be seen quite frequently on computed tomography (CT) of the body. This offers the possibility to detect incidental pathology and help to improve patient outcome. Basic knowledge about imaging findings of breast implants on CT is therefore needed for radiologists reporting body CT. CT may also be used for further workup of breast implants if magnetic resonance imaging (MRI) is contraindicated or not available. The purpose of this pictorial review is to give a brief overview of normal and pathologic findings of breast implants on CT.

Interleukin 17 and senescent cells regulate the foreign body response to synthetic material implants in mice and humans

Medical devices and implants made of synthetic materials can induce an immune-mediated process when implanted in the body called the foreign body response, which results in formation of a fibrous capsule around the implant. To explore the immune and stromal connections underpinning the foreign body response, we analyzed fibrotic capsules surrounding surgically excised human breast implants from 12 individuals. We found increased numbers of interleukin 17 (IL17)-producing γδ⁺ T cells and CD4⁺ T helper 17 (T_H17) cells as well as senescent stromal cells in the fibrotic capsules. Further analysis in a murine model demonstrated an early innate IL17 response to implanted synthetic material (polycaprolactone) particles that was mediated by innate lymphoid cells and γδ⁺ T cells. This was followed by a chronic adaptive CD4⁺ T_H17 cell response that was antigen dependent. Synthetic materials with varying chemical and physical properties implanted either in injured muscle or subcutaneously induced similar IL17 responses in mice. Mice deficient in IL17 signaling established that IL17 was required for the fibrotic response to implanted synthetic materials and the development of p16^INK4a senescent cells. IL6 produced by senescent cells was sufficient for the induction of IL17 expression in T cells. Treatment with a senolytic agent (navitoclax) that killed senescent cells reduced IL17 expression and fibrosis in the mouse implant model. Discovery of a feed-forward loop between the T_H17 immune response and the senescence response to implanted synthetic materials introduces new targets for therapeutic intervention in the foreign body response.

Fabrication and Analysis of Polydimethylsiloxane (PDMS) Microchannels for Biomedical Application

In this research work, Polydimethylsiloxane (PDMS) has been used for the fabrication of microchannels for biomedical application. Under the internet of things (IoT)-based controlled environment, the authors have simulated and fabricated bio-endurable, biocompatible and bioengineered PDMS-based microchannels for varicose veins implantation exclusively to avoid tissue damaging. Five curved ascending curvilinear micro-channel (5CACMC) and five curved descending curvilinear micro-channels (5CDCMC) are simulated by MATLAB (The Math-Works, Natick, MA, USA) and ANSYS (ANSYS, The University of Lahore, Pakistan) with actual environments and confirmed experimentally. The total length of each channel is 1.6 cm. The diameter of both channels is 400 µm. In the ascending channel, the first to fifth curve cycles have the radii of 2.5 mm, 5 mm, 7.5 mm, 10 mm, and 2.5 mm respectively. In the descending channel, the first and second curve cycles have the radii of 12.5 mm and 10 mm respectively. The third to fifth cycles have the radii of 7.5 mm, 5 mm, and 2.5 mm respectively. For 5CACMC, at Reynolds number of 185, the values of the flow rates, velocities and pressure drops are 19.7 µLs−1, 0.105 mm/s and 1.18 Pa for Fuzzy simulation, 19.3 µLs−1, 0.1543 mm/s and 1.6 Pa for ANSYS simulation and 18.23 µLs−1, 0.1332 mm/s and 1.5 Pa in the experiment. For 5CDCMC, at Reynolds number 143, the values of the flow rates, velocities and pressure drops are 15.4 µLs−1, 0.1032 mm/s and 1.15 Pa for Fuzzy simulation, 15.0 µLs−1, 0.120 mm/s and 1.22 Pa for ANSYS simulation and 14.08 µLs−1, 0.105 mm/s and 1.18 Pa in the experiment. Both channels have three inputs and one output. In order to observe Dean Flow, Dean numbers are also calculated. Therefore, both PDMS channels can be implanted in place of varicose veins to have natural blood flow.

Pulmonary fibrosis and embolism secondary to silicon implant leak

Pulmonary fibrosis in a patient with history of ruptured silicone breast implants may present a therapeutic challenge to diagnose and treat. In this case report, we aim to discuss our experience in diagnosing a patient with chronic silicone embolism syndrome masquerading as refractory multifocal pneumonia that presented with respiratory failure. A young woman with no significant past exposure having recurrent admissions to the hospital due to fever and shortness of breath was found to have chronic silicone embolism with pneumonitis. This case report emphasis the prompt diagnosis and treatment of silicone induced fibrosis and approach to the most common side effects of breast implants.