Left Unilateral Breast Autoinflation and Intraprosthetic Collection of Sterile Pus: An Unusual Operative Finding of Silicone Gel Bleed with Silicone Lymphadenitis

Abstract

Implant rupture is a known complication after augmentation mammoplasty. Saline implant failure may present with few diagnosable problems due to the loss of volume. On the other hand, intracapsular silicone gel implant rupture or failure can be silent, asymptomatic, and difficult to diagnose in the absence of loss of breast volume. Silicone leak and migration to regional nodes has been reported but is uncommon and lymph node enlargement can be nonspecific in patients with intact prostheses. Causes, timing, and diagnosis of implant failure sites and mechanisms have been extensively studied and reported in the literature. Implant failure resulting in lymphadenopathy is uncommon. In this article autoinflation of the left breast with regional lymphadenopathy is presented. Upon exploration, the prosthesis was found to be filled with sterile pus, showing an inward movement of a thick creamy material in an otherwise macroscopically intact prosthesis.

Pathogenesis, presentation and classification of late autoinflation of the breasts: case report and literature search

“…Collection of thick mucinous creamy fluid, resembling like pus but with out positive bacterial culture, is uncommon and is possibly due to a chemical reaction in response to the leaked silicone. [11][12][13] This type of collection is reported following PIP silicone and hydrogel implant ruptures [11][12][13] and PAAG injections. [15,16] The cause is the direct contact of the material with the body either through a rupture or following implantation or injection of PAAG.…”

“…Intraprosthetic collection of fluid or sterile pus though not very common has been reported both in saline as well as silicone gel implants. [11][12][13][14] However the process differs in the two instances. In saline implants, the shell allows passage of protein macromolecules, predominantly albumin that creates an osmotic gradient across the macroscopically intact silicone shell allowing body fluids to enter the prosthesis.…”

“…[14] On the contrary, intraprosthetic collection of fluid in silicone gel implant is almost always associated with damaged or ruptured shell that may or may not be macroscopically visible and there is almost always intracapsular collection of fluid or sterile pus at the same time. [11][12][13] The damaged shell allows intracapsular fluid to gain access to the inside of the damaged implant resulting in autoinflation of the breast.…”

“…[9,10] Implant rupture may occasionally present as spontaneous autoinflation of the breast. [11][12][13] In contrast saline implant can deflate following its rupture. Rarely a saline implant can present with autoinflation of the breast without a rupture or breach in the shell of the implant.…”

Adenopatía axilar por siliconas: revisión. Algoritmo de estudio y tratamiento

“…12 Mientras otros estudios informan una tasa de rotura que oscila entre el 0,3% y el 77%. 13 La calidad de los implantes también afecta su vida útil.…”