Evaluation and treatment of surgical management of silicone mastitis

Abstract

Injected liquid silicone continues to be employed by unscrupulous practitioners in many parts of the world for the purpose of breast augmentation. Complications vary; however, inflammation, foreign body reaction, and granuloma formation often lead to painful and disfigured breasts. Furthermore, migrations of silicone to remote tissues cause additional problems. We present a review of cases and propose an updated algorithm for the diagnosis and management silicone mastitis. We describe two representative cases of mastitis cause by injected liquid silicone. Patients uniformly developed inflammation and granuloma formation causing painful and disfigured breasts. Each patient required bilateral mastectomy and breast reconstruction. Although injection of liquid silicone has been condemned by the legitimate medical community for the purpose of breast augmentation, it continues to be illicitly performed and there exists a sizable patient population suffering from the complications of this procedure. Accurate identification requires a high index of suspicion in patients presenting with firm and painful breasts. An aggressive management strategy is recommended in the setting of silicone mastitis due to the risk of obscuring malignancy.

Giant siliconoma mimicking locally advanced breast cancer: A case report and review of literature

“…Typical MRI findings for siliconomas include evidence of implant collapse with free silicone particles outside the prosthetic shell and in the tissue surrounding the fibrous shell that forms around the implant. These findings in the context of rupture can reliably diagnose siliconoma and exclude malignancy [ 10 , 11 ]. Contrast enhancement of siliconomas on MRI is atypical but occurred in our patient and another reported by Grubstein et al [ 6 ].…”

“…Patients may prefer to forgo surgery for minimally or asymptomatic lesions [ 13 ]. However, surgical removal of siliconomas also prevents their obfuscation of future cancer screening and workup [ 10 ]. Thus, a patient’s risk for developing breast cancer should factor into their decision.…”

Management of asymptomatic silicone-injected breast with reduction mammoplasty

“…Most common are the formation of Silicone granuloma and Silicone mastitis. [ 3 5 6 ] Nevertheless, the development of symptoms is different for each individual. Some patients may live with injectable Silicone inside their body without any serious symptoms (asymptomatic).…”

“…Until now, there is no guideline regarding the diagnosis and management of breasts injected with Silicone, although several studies have proposed algorithms for the management of “symptomatic” injected breasts. [ 1 2 3 ] For asymptomatic injected breasts, the management is still unclear and has never been reported exclusively. Herein, we present two cases of asymptomatic patients with a history of liquid Silicone injections who refused to have a mastectomy and chose instead to undergo reduction mammoplasty to enhance the appearance of their breasts.…”