Silicone breast implant rupture presenting as bilateral leg nodules
Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel.Clinical and Experimental Dermatology (Impact Factor: 1.09). 06/2009; 34(5):e99-101. DOI: 10.1111/j.1365-2230.2008.03196.x
Gross migration of silicone gel from ruptured breast implants is a rare event. It is associated with extravasation of gel into the breast parenchyma, and to distant locations such as the abdominal wall and inguinal areas. This silicone deposits present as subcutaneous nodules and cause a local reaction known as siliconoma. We evaluated a 56-year-old woman who presented with a 2-year history of painful, firm and ill-defined subcutaneous nodules on the medial aspect of the shins and ankles. Her medical history was notable for bilateral breast augmentation with silicone implants 30 years before presentation. Although there were no signs or symptoms on breast examination, ultrasonography and magnetic resonance imaging confirmed that both implants had ruptured. Histological examination of a punch biopsy from a nodule on the shin found lobular granulomatous panniculitis. An excisional biopsy of the lesion was analysed by scanning electron microscopy and was found to contain silicone. This is a rare case of gross migration of silicone to the shins, originating from ruptured breast implants. To our knowledge, there is no previous report of silicone migration to such a distant location. We discuss the common presentation of silicone migration and highlight the importance of awareness among dermatologists and plastic surgeons about this unusual occurrence.
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ABSTRACT: Silicone breast implants are commonly used in breast surgery, either for esthetic or reconstructive procedures. There have been several case reports of silicone migration, with or without implant rupture. One of the possible consequences of such migration is the formation of siliconomas.We performed an exhaustive review of the literature, which is relatively scarce and disperse, on the diagnosis, treatment, and possible complications of this entity and its differential diagnosis with breast cancer and axillary metastasis. This article also discusses the latest available information and recommendations on Poly Implant Prostheses. Due to their characteristics, these implants show a high frequency of rupture, silicone migration, siliconomas, and related complications.The rate of silicoma formation is unknown but is strongly associated with implant rupture and subsequent gel migration. The breast implants of choice are those made of highly cohesive silicone gel. The most important problem associated with siliconomas is the differential diagnosis with breast cancer and axillary metastasis, in which magnetic resonance is the gold standard diagnostic technique.Once a silicoma has been diagnosed, the most suitable option is its surgical removal and implant replacement.
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ABSTRACT: Treatment of patients experiencing adverse health effects following prosthetic mammoplasty has suffered from a lack of an acknowledgment of a causal relationship to their breast prosthetic devices. Case reports and case series showing an association between adverse health effects and breast implants have been routinely dismissed as anecdotal, and epidemiological studies have been considered necessary to prove causality. We show that epidemiological research is not necessary for establishing a causal relationship, and one properly documented case can be, in fact, all that is needed to show causation. Presently in the peer-reviewed literature there exists a substantial scientifically sound body of data showing an association between breast implants and adverse health effects. Ample evidence has shown that exposure to the five common types of breast implants outlined, i.e., silicone gel filled, saline filled, double lumen, polyurethane coated, and cohesive silicone, has caused adverse health effects in humans. Prosthetic mammoplasty sensitivity syndrome (PMSS) is the proposed term to describe the disease processes documented in the literature that has a causal relationship to breast implants.