Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases

Abstract

The differential diagnosis of hepatic granulomas is vast and includes infections, drugs, immunologic diseases, foreign material exposure, and neoplasia. Silicone, whether directly injected into tissues or used as a filler in breast implants, is known to cause localized granulomatous reactions. It can also migrate to other anatomic locations resulting in granulomatous inflammation at a distance. We report two cases of unsuspected hepatic silicone granulomas in patients undergoing liver biopsy for isolated elevated alkaline phosphatase levels, both with a history of ruptured breast implants. These cases highlight the need for awareness of hepatic silicone granulomas as an etiology of elevated liver enzymes in patients with a history of surgical interventions utilizing silica, such as cosmetic surgery.

Hepatobiliary complications from ruptured silicone breast implants – a comprehensive literature review

“…The search strategy revealed paucity of literature in the research topic, with 3 papers (4 case reports) describing hepatobiliary complications after ruptured silicone breast implants [ 7 ], [ 8 ], [ 9 ]. A paper by Tan et al (titled: hepatobiliary complications following breast implants: a case report and literature review) was excluded, as the paper has since been retracted from literature by the time the authors of this paper finished writing.…”

“…The mean age in years at the time of presentation was 50 (range:38–58). Information about ethnicity was available in all the papers: 3 Caucasians [ 8 ], [ 9 ]; and 1 Hispanic [ 7 ].…”

“…Abdominal pain (right upper quadrant and epigastric pain) was the most common presenting complaint [ 7 ], [ 9 ]. 1 patient presented with symptoms of chronic liver disease; pruritis and lethargy [ 7 ] and weight loss [ 8 ].…”

“…1 patient had Sjogren’s disease with positive anti-Ro antibodies [ 7 ]. Another patient had a history of iron-deficiency anaemia secondary to menorrhagia requiring regular iron supplements [ 8 ]. Quicke’s oedema was reported in a patient with recurrent episodes of facial swelling [ 9 ].…”

“…All the patients had deranged LFTs on admission. Alanine transaminase (ALT) and aspartate aminotransferase (AST) were commonly raised [ 7 ], [ 8 ]. Patients presenting much later after implants were inserted presented with greater LFTs derangement.…”