Monitoring the axilla in patients with silicone gel implants.
Migration of silicone beyond the breast implant capsule may occur as a result of silicone bleed, leak, or rupture, and it may indicate failure of implant envelope integrity. We report a series of 23 patients with silicone implants who had axillary lymph node biopsies for palpable masses. Group 1 (n = 15) had biopsies performed an average of 6 years following aesthetic augmentation, and Group 2 (n = 8) had biopsies performed an average of 5 years after mastectomy reconstruction. All biopsies demonstrated foreign body reaction consistent with silicone migration. Five patients in Group 1 and two in Group 2 also had breast cancer detected by the axillary biopsy. Evaluation of the axilla utilized a combination of one or more techniques, including mammography, ultrasonography, magnetic resonance imaging, and fine-needle aspiration. We conclude that (1) routine evaluation of the axilla is mandatory in all patients with silicone breast implants; (2) an algorithmic approach in diagnosing axillary masses may be helpful, especially in augmentation patients; and (3) axillary masses detected by clinical examination or other means must be biopsied, even in the face of negative screening studies, because breast cancer may be coincidental with a silicone granuloma.
Kulber
D A
DA
Department of Plastic Surgery, New York Hospital, Cornell Medical Center, NY 10021, USA.
Mackenzie
D
D
Steiner
J H
JH
Glassman
H
H
Hopp
D
D
Hiatt
J R
JR
Hoffman
L
L
D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology*; D001707:Biopsy, Needle; D018427:Breast Implants; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000473:pathology*; D005782:Gels; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D012828:Silicones / Q000009:adverse effects*
D005782:Gels; D012828:Silicones