Management of Contralateral Breast and Axillary Nodes Silicone Migration after Implant Rupture

Abstract

Background: Silicone implants were developed in 1962 for breast augmentation and became essential in reconstruction after mastectomy. Silicone “bleeding” has been described from both ruptured and intact implants and can induce disseminated granulomatosis due to the component's high fat solubility. If not adequately treated, they can lead to disastrous cosmetic and functional consequences. Because they may mimic malignancy, prompt and reliable diagnosis should be made as early as possible. Methods: We present a clinical case description of multiple intraparenchymal and ipsi/contralateral intraganglionic siliconomas in a woman who had undergone breast reconstruction, and a literature review of the pathophysiology of siliconomas and their diagnosis and management. Results: Silicone migration to the contralateral breast and lymph node is rare and has seldom been described. The mechanism is still debated. Excluding malignancy is a priority, and systematic management must be respected to avoid misdiagnosis or unnecessary investigations. Conclusions: A multidisciplinary approach is essential for siliconoma management. Silicone-related lymphadenopathies do not require follow-up or special treatment unless they interfere with the diagnosis of tumor recurrence. Careful observation is sufficient for asymptomatic siliconomas; however, symptomatic ones should be treated depending on skin involvement and the patient's eligibility for intervention.

The Spectrum of Non-neoplastic Changes Associated With Breast Implants

“…Siliconomas appear to arise from the release of silicone contents into the surrounding capsule or soft tissue. 72,73…”

“…Affected patients usually describe single or multiple indurated, palpable, or painful nodules or masses in the breast, with a range of sizes. [72][73][74][75] Ipsilateral, or rarely contralateral, regional lymph nodes (internal mammary chain, axillary, and supraclavicular) may also be affected. 72,74,76,77 Imaging Silicone granulomas are often associated with implant rupture.…”

“…[72][73][74][75] Ipsilateral, or rarely contralateral, regional lymph nodes (internal mammary chain, axillary, and supraclavicular) may also be affected. 72,74,76,77 Imaging Silicone granulomas are often associated with implant rupture. 78 On mammography, siliconomas typically exhibit irregular or circumscribed high-density masses.…”

“…Features that suggest silicone reaction instead of malignancy include a preserved lymph node hilum and a low standard uptake value on PET-CT, whereas malignancy shows a high standard uptake value. 72 Cases associated with acute or chronic inflammation or fat necrosis may lead to a false-positive uptake in PET-CT and should be associated with other imaging modalities for a better interpretation of the results. 72,99 Pathologic Features FNA, incisional biopsy, or excisional biopsy are often necessary to define the nature of the LAD.…”

“…72 Cases associated with acute or chronic inflammation or fat necrosis may lead to a false-positive uptake in PET-CT and should be associated with other imaging modalities for a better interpretation of the results. 72,99 Pathologic Features FNA, incisional biopsy, or excisional biopsy are often necessary to define the nature of the LAD. 100 Histologically, there is silicone deposition in inflammatory cells, or is implied by the presence of foamy histiocytes with empty vacuoles.…”