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

Abstract

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 Migration from Intact Saline Breast Implants

“…Prior research suggested the potential for silicone leakage directly from the PDMS elastomer shell using spectroscopic analysis. 8 , 9 Silicone leakage may occur due to shell degradation cause by mechanical forces and interactions with the body. Although the basic design of saline implants has been maintained, specific information about changes in manufacturing processes is not readily available.…”

“…Contrary to the presumed inertness of silicone, leaked particles from implants can spread within the body, triggering inflammatory responses such as granuloma formation, and lymphadenopathy mimicking malignancies on positron emission tomography imaging. 6 , 9 , 10 These clinical observations underscore the need to investigate the systemic health complaints reported by patients with various types of breast implants.…”

Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands

“…Data on silicone leakage from cohesive gel SBIs is scarce, 21 , 22 and little data exist concerning leakage and migration. A recent case of silicone and sarcoid granulomas in a patient with highly cohesive SBIs was described in a 2021 study by Nanayakkara et al 23 …”

“…20 Data on silicone leakage from cohesive gel SBIs is scarce, 21,22 and little data exist concerning leakage and migration. A recent case of silicone and sarcoid granulomas in a patient with highly cohesive SBIs was described in a 2021 study by Nanayakkara et al 23 Large case series in which data on gel bleed and migration in patients with noncohesive and cohesive gel SBIs are compared are lacking. The aim of this study is to gain more clarity and insights about the prevalence of silicone leakage in patients with noncohesive or cohesive SBIs.…”

Breast implant iatrogenics: challenging the safety narrative

“…Timely detection of silicone leakage, due to ruptures or extensive bleeding from intact implants, is crucial to mitigate the risks of unpredictable silicone migration, as exemplified by disturbing case reports. Migrating silicone particles can induce inflammation leading to silicone-induced lymphadenopathy ( 7 ), acute respiratory distress syndrome ( 8 , 9 ), chronic pulmonary embolism ( 9 , 10 ), sarcoidosis ( 11 ) and scleroderma of the skin ( 12 ). Granuloma formation may occur ( 13 ), potentially resulting in embolism formation and hematological spread to, for example, the carotid artery leading to ocular muscle palsy ( 14 ).…”