Figure 1
Teaching Case
SectionBreast imaging
Case TypeClinical Cases
AuthorsIvo Ferreira, Manuela Certo
Connected authors
36 years, female
A 36-year-old woman came to the surgery consultation complaining of bilateral breast pain and palpable nodules.
At physical examination, several well-defined nodules were palpable in both breasts and skin thickening was observed.
The patient denied familial history of breast cancer.
At physical examination, several well-defined nodules were palpable in both breasts and skin thickening was observed.
The patient denied familial history of breast cancer.
Breast siliconomas
Breast siliconomas
Multiple breast cysts
Breast cancer
Mammography study confirmed multiple nodular lesions of different sizes, diffusely distributed, all of them with rounded shape and well-defined. It was also possible to observe significant thickening of the skin. There was no irregular or spiculated lesion.
The ultrasound images show the presence of multiple cystic lesions with snowstorm pattern.
The ultrasound images show the presence of multiple cystic lesions with snowstorm pattern.
The first reports of injection of liquid silicon as a form of plastic surgery date back to the end of the 40ies [1], with consistent data of its use for breast augmentation a few years later. [2]
It took only a short time until several reports of different complications of the procedure appeared, with spotlight on breast pain and tenderness [3], the main symptoms reported by our patient. As a result this approach was then discontinued and forbidden in several countries. Unfortunately, this did not avoid that it was still performed, in the vast majority of times under unclear medical conditions.
The accuracy of mammography and ultrasound in detecting occult carcinoma in cases like this is low. Better evaluation can be obtained with MRI [4, 5], yet there are already reports on MRI and even PET-CT false positive results because of the active inflammation of surrounding tissue as a response to silicone. [6]
It was decided by a multidisciplinary consultation that the MRI would not change the treatment option in this patient.
Surgery is indicated in all symptomatic patients [7], and the preferable technique is the subcutaneous mastectomy, as it was performed in our patient.
The approach to breast reconstruction is more variable and there is no consensus on which one should be performed. Some surgeons prefer transverse rectus abdominis myocutaneous flap or deep inferior epigastric perforator flap [8, 9], but in this patient the plastic surgeons preferred reconstruction with prosthesis.
Nowadays there are still women who undergo aesthetical procedures offered by providers who are not medically certified. We keep seeing breast siliconomas and sometimes they are very difficult to differentiate from breast cancer, even with advanced techniques as previously referred.
The most important delayed symptoms include inflammation, pain and silicone migration.
It took only a short time until several reports of different complications of the procedure appeared, with spotlight on breast pain and tenderness [3], the main symptoms reported by our patient. As a result this approach was then discontinued and forbidden in several countries. Unfortunately, this did not avoid that it was still performed, in the vast majority of times under unclear medical conditions.
The accuracy of mammography and ultrasound in detecting occult carcinoma in cases like this is low. Better evaluation can be obtained with MRI [4, 5], yet there are already reports on MRI and even PET-CT false positive results because of the active inflammation of surrounding tissue as a response to silicone. [6]
It was decided by a multidisciplinary consultation that the MRI would not change the treatment option in this patient.
Surgery is indicated in all symptomatic patients [7], and the preferable technique is the subcutaneous mastectomy, as it was performed in our patient.
The approach to breast reconstruction is more variable and there is no consensus on which one should be performed. Some surgeons prefer transverse rectus abdominis myocutaneous flap or deep inferior epigastric perforator flap [8, 9], but in this patient the plastic surgeons preferred reconstruction with prosthesis.
Nowadays there are still women who undergo aesthetical procedures offered by providers who are not medically certified. We keep seeing breast siliconomas and sometimes they are very difficult to differentiate from breast cancer, even with advanced techniques as previously referred.
The most important delayed symptoms include inflammation, pain and silicone migration.
References
[1] Narins RS, Beer K (2006) Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 118(3 Suppl):77S-84S (PMID: 16936547)
[2] Beekman WH, Hage JJ, Jorna LB, Mulder JW (1999) Augmentation mammaplasty: the story before the silicone bag prosthesis. Ann Plast Surg 43(4):446-51 (PMID: 10517477)
[3] Boo-Chai K (1969) The complications of augmentation mammaplasty by silicone injection. Br J Plast Surg 22(3):281-5 (PMID: 5394228)
[4] O\'Toole M, Caskey CI (2000) Imaging spectrum of breast implant complications: mammography, ultrasound, and magnetic resonance imaging. Semin Ultrasound CT MR 21(5):351-61 (PMID: 11071616)
[5] Peng HL, Wu CC, Choi WM, Hui MS, Lu TN, Chen LK (1999) Breast cancer detection using magnetic resonance imaging in breasts injected with liquid silicone. Plast Reconstr Surg 104(7):2116-20 (PMID: 11149777)
[6] Grubstein A, Cohen M, Steinmetz A, Cohen D (2011) Siliconomas mimicking cancer. Clin Imaging 35(3):228-31 (PMID: 21513863)
[7] Luo SK, Chen GP, Sun ZS, Cheng NX (2011) Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients. J Plast Reconstr Aesthet Surg 64(6):731-7 (PMID: 21074506)
[8] Chiu WK, Lee TP, Chen SY, Li CC, Wang CH, Chen SG (2012) Bilateral breast reconstruction with a pedicled transverse rectus abdominis myocutaneous flap after subcutaneous mastectomy for symptomatic injected breasts. J Plast Surg Hand Surg 46(3-4):242-7 (PMID: 22909241)
[9] Liu S, Lim AA (2012) Evaluation and treatment of surgical management of silicone mastitis. J Cutan Aesthet Surg 5(3):193-6 (PMID: 23112516)
Case information
| URL: | https://www.eurorad.org/case/12041 |
| DOI: | 10.1594/EURORAD/CASE.12041 |
| ISSN: | 1563-4086 |
Figure 2
Figure 3
Figure 2
Ferreira I, Department of Radiology, Centro Hospitalar do Porto, Porto, Portugal
Figure 3
Ferreira I, Department of Radiology, Centro Hospitalar do Porto, Porto, Portugal