Bilateral Silicone Granulomas Mimicking Breast Cancer Recurrence on 18F-FDG PET/CT

Abstract

We report the case of a 45-year-old woman with a history of right breast reconstruction with silicone implant for breast cancer. An 18F-FDG PET/CT performed several years later revealed the presence of 18F-FDG–avid nodules at the periphery of the silicone implant, in the right internal mammary chain, and in the contralateral breast. Needle core biopsies were positive for bilateral silicone granulomas, without any sign of malignancy. This case displays intense 18F-FDG uptake in silicone granulomas affecting the contralateral breast after implant reconstruction.

FDG Localization in Acellular Dermal Matrix, a Potential Cause of Nonpernicious Uptake Following Breast Reconstruction Surgery

“…Reversal of uptake corresponds to resolution of ADM neovascularization and inflammation, which is typically seen approximately 8 weeks after implantation. 6 Previously described etiologies of false-positive FDG uptake associated with mastectomy and breast reconstruction include granulomatous tissue reaction, 7 silicone granulomata, 8 and foreign body giant cell reactions. 9 When biological matrix material is used, ADM-associated uptake should be recognized as another potential benign cause of uptake, reflecting cellular incorporation and neovascularization of the matrix, rather than recurrent tumor or infection.…”

Breast implant iatrogenics: challenging the safety narrative

“…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 ). Migration of silicone particles to distant organs can also occur from intact implants ( 15 – 17 ).…”

Relapsed Breast Implant–Associated Anaplastic Large-Cell Lymphoma Presenting as Refractory Fluid Collections With Low Uptake on FDG PET/CT Scan

“…4 BIA-ALCL can also complicate silicone implant granulomas, which originally form due to silicone-induced granulomatous reaction on the implant's capsule. 5 The average time to the diagnosis of BIA-ALCL is approximately 7 to 10 years after breast implantation; the diagnosis is commonly delayed due to nonspecific presenting symptoms. 6,7 BIA-ALCL is typically associated with an intense uptake of FDG PT/CT scan.…”

“…The underlying pathophysiology of BIA-ALCL is poorly understood; however, immunological mechanisms involving T cells proliferation and the associated inflammation have been postulated 4 . BIA-ALCL can also complicate silicone implant granulomas, which originally form due to silicone-induced granulomatous reaction on the implant’s capsule 5 . The average time to the diagnosis of BIA-ALCL is approximately 7 to 10 years after breast implantation; the diagnosis is commonly delayed due to nonspecific presenting symptoms 6,7 .…”