Advertisement
Short reports and correspondence| Volume 56, ISSUE 5, P518-519, July 2003

Leakage and silicone lymphadenopathy with cohesive breast implant

      Since the silicone breast implant was introduced in the early 1960s, it has been widely used for cosmetic and reconstructive breast surgery. Although a recent review by the Department of Health (IRG report)

      Department of Health, the report of the Independent Review Group, Breast implants: Information for women considering breast implants. www.doh.gov.uk/implants.

      has shown no relationship between the silicone breast implant and systemic complications, leakage of the silicone into the tissue and migration to the regional lymph nodes remains a clinical concern. New implants filled with cohesive silicone were introduced a decade ago. It was widely suggested that the cohesive gel implants are less likely to leak even if the shell ruptures. The IRG report included a similar suggestion.

      Department of Health, the report of the Independent Review Group, Breast implants: Information for women considering breast implants. www.doh.gov.uk/implants.

      We present a case of a 44-year-old lady who had bilateral cohesive breast implants for cosmetic reason. Twelve months after her surgery, she presented with a palpable lymph node in her left axilla. Fine needle aspiration biopsy of the lymph node revealed silicone lymphadenopathy and MRI of the breasts revealed rupture of the left breast implant. The ruptured implant was subsequently replaced (Fig. 1) and the lymph node was excised. Histological examination showed a 4×4 cm2 lymph node, entirely replaced with silicone particles (Fig. 2) .
      Figure thumbnail gr1
      Fig. 1The ruptured implant after removal.
      Figure thumbnail gr2
      Fig. 2The excised lymph node was entirely replaced with silicone particles.
      Silicone is a synthetic polymer (chain) of dimethylsiloxane. It exists in fluid, gel and solid form according to the length of the polymer. The fluid form has a small and simple chain while the solid form has a longer and more complicated chain. Leakage and migration into the tissue was linked more to silicone with smaller size chain.
      • LeVier R.R.
      • Harrison M.C.
      • Cook R.R.
      • Lane T.H.
      What is silicone?.
      However, silicone migration and lymphadenopathy is well-documented complication with the solid form, e.g. joint replacement
      • Roux S.P.
      • Bertucci G.M.
      • Ibarra J.A.
      • Blatt G.
      • Ashworth C.R.
      Unilateral axillary adenopathy secondary to a silicone wrist implant: report of a case detected at screening mammography.
      and testicular prosthesis.
      • Doherty A.P.
      • Mannion E.M.
      • Moss J.
      • Ockrim J.L.
      • Christmas T.J.
      Spread of silicone to inguinal lymph nodes from a leaking testicular prosthesis: a cause for chronic fatigue?.
      This case raises concerns about the suggestion that cohesive gel containing implants are less likely to leak and the associated implication that lymphadenopathy is less likely.
      Although leakage and migration is linked to implants filled with softer semi-liquid silicone, we believe that it could also happen with more cohesive form of silicone gel containing implants.

      References

      1. Department of Health, the report of the Independent Review Group, Breast implants: Information for women considering breast implants. www.doh.gov.uk/implants.

        • LeVier R.R.
        • Harrison M.C.
        • Cook R.R.
        • Lane T.H.
        What is silicone?.
        Plast Reconstr Surg. 1993; 92: 163
        • Roux S.P.
        • Bertucci G.M.
        • Ibarra J.A.
        • Blatt G.
        • Ashworth C.R.
        Unilateral axillary adenopathy secondary to a silicone wrist implant: report of a case detected at screening mammography.
        Radiology. 1996; 198 (Feb): 345-346
        • Doherty A.P.
        • Mannion E.M.
        • Moss J.
        • Ockrim J.L.
        • Christmas T.J.
        Spread of silicone to inguinal lymph nodes from a leaking testicular prosthesis: a cause for chronic fatigue?.
        BJU Int. 2000; 86: 1090