Further to the case report: Locoregional silicone spread after high cohesive gel silicone implant rupture (Lahiri and Waters, J Plast Reconstr Aesthet Surg 2006;59:885–6), I write to report a similar case, again involving an implant manufactured by Poly Implant Prostheses, France.
In this case, AP, a thirty-six-year old woman was referred by her GP to a breast surgeon with a lump in the right axilla. She had undergone bilateral augmentation with saline implants eight years previously and, following deflation on the right, these had been exchanged for PIP cohesive gel five years later.
The breast surgeon confirmed the presence of an enlarged right axillary lymph node and noted that the right breast was larger than the left. He performed excision biopsy of the node, histology of which showed vacuolated cells, foamy macrophages and multinucleated giant cells in keeping with a silicone lymphadenopathy.
She was referred to me and at exploration of the right breast I found, like Lahiri and Waters, that there was huge tear in the shell of the implant (Fig. 1).
The cohesive gel had remained in situ but the implant was surrounded by a considerable quantity – approximately 50 ml – of cloudy, viscous fluid, presumably serous in origin, which explained the enlargement of the breast.
That a high cohesive gel implant could have suffered such a massive failure only three years after implantation is very worrying and, in this case, not only had silicone migrated to a regional lymph node, but the exposed silicone gel appears to have provoked an inflammatory response with the production of a significant quantity of serous exudate.
In view of these two reports the reliability of PIP implants must be questioned and, for myself, I intend to discontinue their use in favour of implants from other manufacturers.
Published online: April 24, 2007
© 2007 Published by Elsevier Inc.