Silicone after breast implant rupture

Clinical History

A 70-year-old woman received a mammography as part of a preventive medical check-up. She reported that she underwent a breast augmentation of both sides in 1965. The augmentation was necessary due to cosmetic reasons. In 2002 both breast implants were removed. An accident in the history or breast pain was negated.

Imaging Findings

On mammography multiple small hyperdens nodules, which were sharply circumscribed could be detected on the left side (Fig. 1-2). They had a seize from 0.5 up to 2.0 cm. The nodules were hyperreflexiv in ultrasound (Fig. 3, left side). The shape of all lesions was diffuse. All nodules showed a decreased elasticity in the following elastography (Fig. 3, right side). MRI demonstrated an increased signal in T2-stir weighted sequence on the left side (Fig. 4). The T1 weighted fat-suppressed sequence after intravenous application of contrast medium demonstrated no enhancement of any lesion.
Differential Diagnoses include Breast cancer, Cysts, Silicone after breast implant rupture, Lymphoma and Fibroadenomas.

Discussion

Today the number of women receiving breast implants of silicone gel for augmentation and reconstruction is increasing. Silicon implants are able to cause local complications such capsular contractures, herniations of the implant through rents in the capsules and ruptures. The frequency of ruptures after augmentation and reconstruction could be decreased after the implantation of double lumen implants containing an inner core of silicone gel surrounded by an outer envelope filled with saline. An intra- and extracapsular rupture can be differentiated in modern breast implants in contrast to one-walled implants. The mammography could demonstrate the silicone as hyperdense lesions, which were hyperreflexive in ultrasound. The loss in elasticity made distinguishing between benign and malignant difficult. So MRT was necessary to exclude any malignancy. MRI is the most accurate in identifying silicon implant rupture and localizing free silicone. The free silicone has an increased signal in T2-stir weighted sequence without any enhancement in T1 weighted fat-suppressed sequence. After implant rupture foreign body granulomas can develop in the breast tissue and lymphnodes. Silicon compounds can additionally be found in the blood and liver of woman. The discussion is still controversial, whether silicone has a potential to develop an immunologic reaction and leads to connective tissue disease including rheumatoid arthritis, systemic slcerosis, systemic lupus erythematosus and Sjogren´s syndrome.

Differential Diagnosis List

Final Diagnosis

Silicone after breast implant rupture

URL:	https://www.eurorad.org/case/7471
DOI:	10.1594/EURORAD/CASE.7471
ISSN:	1563-4086