title: Intrapulmonary and cutaneous siliconomas after silent silicone breast implant failure.
abstract: Since the implementation and use of silicone implants in breast surgery the risks are published and discussed. Especially, the incidence of late silicone implant rupture and its potential risk to induce local siliconomas are still under discussion and not sufficiently evaluated. So far literature data offer no information of intrapulmonal or peripheral located cutaneous siliconomas because of systemic migration of silicone after breast augmentation. In light of silicones checkered history, and given the large and growing number of women who choose to undergo breast augmentation surgery each year, the presented clinical findings in our study are likely to be of interest to medical professionals, producers, and consumers alike. We present six female patients with an average age of 55 (+/-5) years with bilateral rupture of silicone implants after breast augmentation for aesthetic reasons. The average time after operation was 18 (+/-6) years. In five patients, we identified peripheral located cutaneous siliconomas and one patient suffered from an intrapulmonal siliconoma. The diagnosis of bilateral rupture of the silicone implants was performed preoperatively by MRI-scans. All five peripheral cutaneous siliconomas and the intrapulmonal siliconoma were validated by histopathologic analysis. Six female patients suffered from bilateral rupture of silicone implants after breast augmentation. In five patients, we identified peripheral located cutaneous siliconomas which were surgically excised. One patient suffered from an intrapulmonal siliconoma. In this unique case a lobectomy with resection of the pulmonal segment 10 had to be performed. Clinical findings of peripheral cutaneous and even intrapulmonary siliconomas after bilateral rupture of silicone breast implants indicate a systemic hematogen or lymphatic pathway of silicone. These findings suggest that it is mandatory to inform the patient about the potential risk of local siliconomas, but also about the potential risk of peripheral cutaneous or even intrapulmonary siliconomas caused by systemic hematogen or lymphatic pathways of silicone after silent implant failure.
authors.affiliation: Department of Plastic and Hand Surgery, University of Erlangen-Nürnberg, University Hospital, 91054 Erlangen, Germany. adrian.dragu@uk-erlangen.de
authors.forename: Adrian
authors.initials: A
authors.lastname: Dragu
authors.forename: Dirk
authors.initials: D
authors.lastname: Theegarten
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Bach
authors.forename: Elias
authors.initials: E
authors.lastname: Polykandriotis
authors.forename: Andreas
authors.initials: A
authors.lastname: Arkudas
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.forename: Giulio
authors.initials: G
authors.lastname: Ingianni
mesh_terms: D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012826:Silicone Elastomers / Q000009:adverse effects*; D020034:Silicone Gels / Q000009:adverse effects*; D012871:Skin Diseases / Q000209:etiology*
chemical_list: D012826:Silicone Elastomers; D020034:Silicone Gels