Silicone Granuloma secondary to ruptured breast implant

Clinical History

A 56 year-old lady referred to the ENT clinic with a 4 week history of a firm right-sided neck swelling. There were no recent illnesses, pain or weight loss.
The patient had a past medical history of lupus and psoriatic arthritis. She also had bilateral breast implants inserted 10 years ago.

Imaging Findings

Ultrasound in February 2015 showed a 1.3cm lesion with acoustic shadowing and an incidental thyroid nodule. FNA was taken from both lesions.

Neck and Chest CT undergone in June 2015 showed a 1.3cm level Vb node and rupture of the right breast implant.

Discussion

On examination the mass was on the right side of the patient's neck, between the medial third of her clavicle and her sternocleidomastoid. It was firm, mildly tender and smooth. It measured about 1 to 1½cm maximal diameter. On palpation it was pulsatile, presumably transmitted due to the nature of the mass and its position. The ENT surgeons were unhappy to perform a fine needle aspiration at the clinic and therefore she was referred for an ultrasound-guided biopsy.

The patient initially underwent ultrasound-guided FNA in February 2015 that was reported as inconclusive.
The decision was made to proceed to excision biopsy of the lesion. This was performed in June 2015. The biopsy sample underwent histological examination that confirmed the diagnosis of silicone granuloma.

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. The rate of implant rupture and its sequelae are not known. Sequelae of rupture include migration of gel accompanied by inflammation and silicone granuloma formation [1].

The pattern of lymph node drainage from the breast has been studied widely.
Estourgie et al. showed that in each quadrant, a breast cancer may drain to sentinel nodes in various locations. Both palpable and nonpalpable lesions may drain toward the internal mammary chain, although the latter more frequently [2].

Migration to mediastinal nodes have also been reported [3].

There is a consensus that silicone granulomas may develop years later and should be surgically excised as soon as they are detected [4].

Differential Diagnosis List

Final Diagnosis

Silicone granuloma secondary to ruptured right breast implant.

URL:	https://www.eurorad.org/case/13208
DOI:	10.1594/EURORAD/CASE.13208
ISSN:	1563-4086