Silicone Granuloma Associated with Pectoral Muscle Involvement after Ruptured Breast Implant: a Novel case report

Abstract

IntroductionSilicone has rapidly become one of the most commonly used prosthetic for breast implants over the last 30 years. Therefore, we have been witnessing more silicone-related disease. Silicone implant rupture, one of the most common silicone-related diseases, occurs more frequently with the implant's age. After implant rupture, silicone leakage can remain within the breast parenchyma or spread to regional lymph nodes first (1). Case studies report silicone migration to distal parts of the body, such as the arm, subcutaneous soft tissues of the abdominal wall and the inguinal area and even to the liver, where silicone causes foreign body inflammation and sometimes mimics malignancy (1). Silicone granuloma associated with pectoral muscle involvement has not been published before.In this study, an unusual case of a patient who was previously operated on a ruptured breast implant following silicone granuloma associated with pectoral muscle involvement is reported, and all imaging modality pattern are shown. Case PresentationA 72-year-old woman was referred to breast radiology department with a pain and hardness in her left breast. The patient had undergone bilateral subglandular breast augmentation surgery when she was 52-year-old. Ten years later, she had silicone implant rupture of left breast, required breast revision surgery and the breast implant and free silicone is removed without replacement. Her right breast was normal. After 10 years of ruptured silicone implant, she complained of pain, hardness, and swelling on her left breast. First of all, to determination of breast cancer and evaluation of the breast parenchyma changes after open removal surgery, a mammography (MG) and breast ultrasonography (US) were performed (IMS Giotto MD digital radiography and Tomosynthesis, Bologna, Italy). The MG showed; diffuse, multiple high-density nodules in the left breast, some with a thin rim of calcifications (Figure 1) Eur J Breast Health 2018; 14: 54-57 DOI: 10.5152/ejbh.2017.3499 54 ABSTRACTIn this study, an unusual case of a patient who was previously operated on a ruptured breast implant following silicone granuloma associated with pectoral muscle involvement is reported. A 72-year-old woman had undergone breast augmentation surgery when she was 52-year-old and silicone implant rupture 10 years later. After 10 years of ruptured silicone implant, her mammography showed diffuse, multiple high-density nodules in the left breast. The pectoral muscle was significantly hypertrophic. The magnetic resonance imaging showed that the pectoral muscle was quite hypertrophic and had heterogeneous enhancement. In clinical consideration and the presence of the suspected malignancy, a biopsy was performed. The histological analysis identified pectoral muscle and breast tissue, which had been mainly replaced by giant cells, along with an apparent foreign body response. Silicone granuloma can present itself as a soft tissue mass. Malignancy is the most important differential diagnosis. Meticulous follow-up is recommended ...

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