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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)
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.
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) .
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.