Silicone Granuloma Associated with Pectoral Muscle Involvement after Ruptured Breast Implant: a Novel case report

Silicone Granulomas in the Orbit following Breast Implant Rupture: Case Report

Introduction

A known but uncommon complication following breast augmentation with silicone implants is the rupture of these implants and subsequent silicone migration through the lymphatic system. Exceptionally, there are sporadic instances of silicone granulomas forming in distant, non-lymphatic sites, posing diagnostic and management challenges in clinical practice.

Case Presentation

A 56-year-old woman presented with slowly progressive diplopia and photosensitivity during the past 12 months. Ophthalmic examination revealed restriction of movement in all gazes in the right eye. Investigation with magnetic resonance imaging and positron emission tomography-computed tomography showed enlarged superior lateral and inferior rectus muscles in the right orbit, and a diffusely enlarged lacrimal gland in the left orbit, as well as a ruptured silicone breast implant on the right side. In addition, multiple enlarged lymph nodes were found throughout the body, as well as a mass in the internal oblique muscle of the abdominal wall. Fine-needle aspiration biopsy of the axillary lymph node and surgical biopsy of extraocular muscles confirmed a diagnosis of silicone granulomas. The patient received anti-inflammatory treatment with intravenous steroids but with no effect on symptoms.

Conclusions

This case illustrates a rare instance of silicone dissemination from a ruptured breast implant leading to granuloma formation in multiple organs, including the orbit. Notably, the spread of silicone appeared to occur through both lymphatic and hematogenous routes. This finding underscores the importance of considering silicone granulomas in the differential diagnosis of orbital lesions for patients with a history of silicone implants.

Get It Off Your Chest: A Narrative Review of Breast Ulcers

GENERAL PURPOSE

To provide comprehensive information about breast ulcers to facilitate accurate diagnosis and treatment of these lesions.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Differentiate common wound complications after mastectomy.2. Identify the clinical manifestations of various types of breast ulcers.3. Explain appropriate pharmacologic and nonpharmacologic treatment options for various types of breast ulcers.

Chest Wall Silicone Granuloma Following Ruptured Silicone Breast Implant Causes Giant Chest Wall Abscess and Osteomyelitis: The First Report

Silicone breast implant ruptures have been widely reported in the literature. Granuloma formation is a known complication of such ruptures with reported sites including the axillae, limbs, chest wall muscles, and internal organs, such as the lungs and the liver. To the best of our knowledge, there are no reported cases of a silicone granuloma causing osteomyelitis of the sternum and multiple ribs in the absence of infection. We therefore report on the case of an 81-year-old patient who presented with an anterior chest wall discharging sinus tract on the background of a ruptured silicone breast implant. We raise awareness about the potentially devastating complications resulting from a ruptured silicone implant with relevance to cardiothoracic practice.

Iatrogenic intrathoracic encapsulated siliconoma from a ruptured breast implant

Our patient was a 57-year-old woman with a history of bilateral retropectoral silicone breast augmentation and axillary hyperhidrosis who underwent a bilateral thoracic sympathectomy via video-assisted thoracoscopic surgery by a surgeon at an outside hospital approximately 20 years ago. The left side required an open thoracotomy. Shortly after the surgery, she developed a left-sided Baker 4 capsular contracture and the left implant was noted to be ruptured. Both implants were exchanged. Several years later the patient began to experience progressive fatigue. Work-up revealed a left lung nodule and she underwent a biopsy that confirmed silicone granulomas. It was hypothesised that at the time of her initial thoracotomy the implant was violated resulting in silicone spillage into the thoracic cavity. The patient was referred to our institution for advanced management of her intrathoracic silicosis. The patient underwent bilateral removal of her silicone implants, total capsulectomy and needle-localised removal of her left thoracic silicone masses. She had an uneventful postoperative course with resolution of her fatigue.