A woman may have silicone breast implants placed to enhance her appearance. The silicone is a viscous gel in a pliable plastic bag. This bag can leak, with release of silicone into the soft tissue.
Reasons for leakage:
(1) trauma, either blunt or penetrating
(2) failure of the plastic
The leakage can be confirmed with imaging studies such as ultrasound or MRI.
Complications of implant rupture:
(1) fibrosis, including hyperplastic scar or keloid
(2) granulomatous mastitis, with pain
(4) entry into ductal system, with emergence at nipple
(5) gravity-based migration to a remote site (upper arm, abdomen, inguinal region)
(6) lymphatic spread to regional lymph nodes with lymphadenitis
(7) difficulty to detect a small breast carcinoma
(8) toxic reaction to impure silicone (in countries with poor regulation or due to fraudulent practitioners)
(9) poor cosmesis due to tissue distortions
Histologic appearance is a lipogranulomatous reaction. The silicone may be removed during tissue processing, resulting in empty vacuoles in tissue sections. Chemical confirmation requires measurement in unprocessed tissue by inductively coupled plasma emission spectroscopy, electron microscopy or other specialized analysis.
The tissue reaction may result in false positive diagnosis:
(1) liposarcoma (confusion with lipoblasts)
(2) sarcoidosis (due to the presence of asteroid bodies)
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Specialty: Obstetrics & Gynecology