IMPLANT RUPTURE AND ANTE-GRADE EXCISION OF AXILLARY SILICONOMA THROUGH IMPLANT POCKET. A CASE REPORT AND LITERATURE SEARCH.

Abstract

Implant rupture is not uncommon and reported incidence varies from 0.3% to 77%. Rupture of a cohesive gel
silicone implant may not be clinically noticeable and finding can be incidental. On the other hand silicone migration to axilla is uncommon and patients presenting with axillary lumps may present a diagnostic problem and
breast screening for breast malignancy is mandatory and must be a part of the investigation. A case report of
axillary siliconoma associated with raised antithyroid antibodies and cervical lymph adenopathy is presented.
Patient had her siliconoma removed through implant pocket in an ante grade fashion to avoid surgical morbidity
associated with direct axillary excision.
Introduction:
Implant rupture is a commonly known complication of breast augmentation and have been reported in saline as
well as silicone implants. The implant rupture in saline implants is clinically obvious due to the loss of its contents, on the other hand, rupture of silicone gel implant is not accompanied with the loss of volume and can be
difficult to pick.1 Lymphadenitis2, autoinflation of breast2,3 and silicone granulomas4 may present as early markers
of a ruptured implant but the signs are not consistent and a rupture of an implants can be silent.1 These localised
or generalised symptoms depend on the amount and extent of leaked silicone. Intracapsular leak does not always generate local or general symptoms due to the biocompatibility of the medically graded silicone and these
ruptures are often found incidentally. Extra capsular leak, on the other hand, often has a higher risk of locoregional complications.2-4
Leaked silicone or gel bleed of an implant is handled and treated by the reticuloendothelial system in the same
way as it deals with the silicone, which our bodies are exposed to, in our daily routine life.5,6 Antibodies to ventriculoendothelial shunts7 and circulating antibodies immunoglobulin G (IgG)8 to silicone, has been reported but further studies did no confirm and challenged the results.9,10 Similarly bilateral areolar depigmentation has been
reported with out any support of anti-melanin antibodies.6
Axillary lymphadenitis has been reported2,4 in the past but raised antithyroid antibodies and silicone granulomas,
with a history of cervical lymphadenopathy, hyper-reflexia of muscle and left shoulder effusion secondary to implant rupture in a patient is presented as a case report.
Keywords: Implant rupture, Siliconoma, Muscle splitting augmentation, Lymphadenopathy, Autoimmune disorders, Silicone leak.