Thoracic Outlet Syndrome Following Breast Implant Rupture

Abstract

Summary:We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient.

Silicone Cervical Lymphadenopathy: A Rare Complication After Breast Augmentation

“…Similar problems have been reported by ophthalmologists and orthopaedists, who often encounter cases of granuloma formation after vitrectomy, silicone oil retinal tamponade or injection of silicone in joints, and silicone joint prosthesis operations [5][6]. However, only a few reports exist on cervical lymphadenopathy associated with breast implants, and these mainly involve single case reports or small case series [7][8][9][10][11][12][13][14][15] (Table 1).…”

“…The duration from breast implantation to silicone cervical lymphadenopathy diagnosis ranged between eight months and 15 years. Pathological lymph nodes were usually located in the right supraclavicular area, although there have been reports of bilateral cervical lymphadenopathy [8,11]. Coexistent axillary lymphadenopathy was usually evident, corresponding to the route of breast lymphatic drainage.…”

“…It is noteworthy that the use of silicone Poly Implant Prosthése (PIP) breast implants was suspended in 2010, after concluding that the silicone gel used by PIP was not medical grade. They had been associated with significantly higher rates of implant rupture and silicone lymphadenopathy [9,11,13,16]. In terms of histological diagnosis of silicone cervical lymphadenopathy, lymph node fine needle aspiration, core biopsy, and excisional biopsy, alone or in combination, have been used.…”

“…Conservative symptomatic treatment is generally recommended, consisting mainly of warm compresses to relieve the pain, which may obviate the need for any systematic therapy. Lymph node excision or clearance may be indicated in cases of persistent symptoms or diagnostic uncertainty, but the condition may recur even after the surgical removal of the diseased nodes [11][12]. Alternative strategies have been proposed for the management of silicone lymph node granulomas, albeit with minimal evidence to support their wide adoption.…”