Rupture of a Hydrogel-Filled Breast Implant

Abstract

In the early 1960s, Cronin and Gerow began to use a silicone bag filled with silicone gel for breast augmentation. Since then, researchers have been looking for different filler materials.An ideal prosthesis does not induce any tissue reaction, is stable, gives the breast a natural appearance, and is radiolucent during mammography. In case of rupture of the envelope, the filler material should be biocompatible, nontoxic, noncarcinogenic, nonteratogenic, and easy to remove during operation. The advantage of using a silicone gel is the natural feeling of the implant and the chemical stability of the gel. 1 Because of the radiodensity of silicone gel, there are difficulties in interpreting mammograms in women with silicone gel-filled implants, thus rendering them less reliable. 2,3 Therefore, materials that were more radiolucent were tested. 4,5 In 1992, U.S. the Food and Drug Administration restricted the use of silicone gel-filled breast implants in the United States because they feared silicone-associated diseases.Carboxyl methyl cellulose is a hydrogel used in the Monobloc breast implant (Laboratoires Arion, Lyon, France). As the manufacturer claims, the prosthesis feels natural, is nonallergenic, and induces less capsular contraction. The filler material is biodegradable and radiolucent. 6 As a result, this filler material can be attractive in countries where the use of silicone-filled breast implants is limited by strict regulations. For patients with a higher risk of breast cancer, a more radiolucent breast implant is necessary for better interpretation of mammograms. Also, for patients anxious about carrying silicone material in their body, the hydrogel-filled breast implant can be an attractive alternative. CASE REPORTWe present a case of a 30-year-old patient with a unilateral increase in volume of one breast. She underwent bilateral breast augmentation 2 years previously. Monobloc, hydrogelfilled textured shell implants were placed in the subglandular position. On her left side, a 240-ml prosthesis was placed, and on her right side, a 260-ml prosthesis was placed. The operative procedure was performed without any complications. One year after operation, our patient suffered from stomach ache and grippe. She visited her physician for several months. Objective signs or symptoms were absent. Laboratory blood results were normal at that time. In the next period, she noticed that her breast size was not constant. She claimed that her left breast had shrunk once in a while.Two years postoperatively, she reported for her yearly checkup. She mentioned that her left breast had lost volume in the last 2 weeks and the right breast size was not changed. At the same time, she had noticed a sensitive swelling in her right axilla. There were no other complaints.On examination, it seemed that the left breast was of normal size, whereas the right breast had increased in volume (Fig. 1). The left breast was not red or painful. In her right axilla, a round and painful tumor, with a diameter of 1 cm, was noticed. Both breast...