Oleomas mimicking cutaneous xanthomas following breast augmentation by injection of liquid silicone

Abstract

Background: Oleoma is defined as a foreign body granuloma resulting from the injection of oily substances into the skin or subcutaneous tissue. Liquid injectable silicone has been used extensively over the last five decades for soft tissue augmentation. Although initially considered as a biologically inert material, it has been implicated in a variety of adverse reactions, sometimes with latent periods of decades. Main observations:We describe the case of a 44-year-old Peruvian woman presenting with multiple painless yellowish papules and plaques limited to the lower half of the breasts, that seemed to be cutaneous xanthomas. A skin biopsy showed granulomatous inflammation with multiple clear vacuoles corresponding to injected liquid silicone particles, diagnosed as oleoma. The patient was then re-evaluated and she reported that she underwent breast augmentation by injection of liquid silicone five prior to presentation in our department. Thus, the diagnosis of oleoma was confirmed. Conclusions:We describe a case with yellowish papules on both breasts in a woman that underwent breast augmentation by injection of liquid silicone. Since this unusual presentation of oleomas can be confused with cutaneous xanthomas, a biopsy is essential for diagnosis. (J Dermatol Case Rep. 2014; 8(1): 13-15)

Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female

“…In several cases similar to the one presented here, patients have refused treatment when extensive surgery was perceived as the only option and were subsequently lost to follow-up. 21,48 For these reasons, the author considers alternatives like intralesional and systemic therapy before excision in most cases. In instances where surgery is appropriate, magnetic resonance imaging (MRI) can be useful in delineating LS migration, limiting the extent of the surgery while decreasing the risk of recurrence.…”

“…Patients often delay seeking help despite the severity of their symptoms and are reluctant to admit to receiving injections abroad or with LS of unknown purity, perhaps due to embarrassment or a fear of being refused treatment. [20][21][22]48 It is therefore vital for physicians to question patients with atypical symptoms thoroughly, repeatedly, and without judgement while looking out for telltale histopathological patterns in biopsy specimens. It is also important to explain to patients that surgical excision is just one of many treatments alternatives that should be considered.…”

Granuloma due to sweet almond oil injection: Difficulties of diagnosis and treatment

“…Injection of oily materials can lead to the formation of FBG, also called as oleoma or paraffinoma. Several substances have been previously described as possible agents of oleoma: paraffin, petrolatum, vegetable oils, liquid petrolatum, hydrous wool fat (lanolin), sesame oil and beeswax [6] . We describe a case of oleoma due to injection of sweet almond oil, a vegetable oil commercialized in regular pharmacies.…”

“…Histopathologically, FBGs may present as many different forms. Paraffinoma due to injection of oils results in a "Swiss cheese" appearance of holes containing lipids [6] . There is variable fibrosis and granulomatous inflammation.…”

Facial Oil-Granuloma due to Almond Oil and Vitamin E Oil Injection

“…Inciting agents could include paraffin, petrolatum, lanolin, vegetable oils, beeswax, etc. [ 2 ] Even though intradermal or subcutaneous injection of oil is not medically indicated for aesthetic purposes, it has been notoriously used by overenthusiastic patients for the same.…”