0
Special Feature |

Image of the Month—Diagnosis FREE

[+] Author Affiliations

Section Editor: Carl E. Bredenberg, MD

More Author Information
Arch Surg. 2010;145(5):498. doi:10.1001/archsurg.2010.67-b.
Text Size: A A A
Published online

Repeated CT of the chest (Figure 1) revealed evidence of an enlarging, ill-defined, 8.2 × 4.0-cm subpectoral mass lateral to the left breast implant, blending with left pectoralis minor and serratus anterior muscles with evidence of leak from the silicone implant. There was no evidence of suspicious lymphadenopathy. Positron emission tomography (Figure 2) showed increased intensity around the implant due to an inflammatory reaction to leakage of the implant. The absence of clinical or radiological lymphadenopathy also rules out the possibility of tumor recurrence or sarcoma. The patient underwent implant removal; there was intraoperative evidence that the mass contained silicone gel around the breast expander that had ruptured, and there was no evidence of recurrence at the surgical bed.

Place holder to copy figure label and caption
Figure 1.

Computed tomography of the chest showing a left subpectoral mass. R indicates right; L, left.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Positron emission tomography of the chest showing increased intensity around the implant. R indicates right; L, left.

Graphic Jump Location

Leakage of silicone gel implants is a common occurrence, with studies indicating an average implant life span of 13 to 15 years.1,2 Implant rupture can be intracapsular or extracapsular.3 Intracapsular rupture is more common and mostly unnoticed because of the fibrous capsule that keeps the free silicone in place. Extracapsular rupture with silicone gel migration has been reported at different locations, including the upper extremity, chest wall muscles, axilla, and back.46 Our patient presented with extracapsular rupture with an enlarging subpectoral and infraclavicular mass. The incidence of implant rupture is approximately 2 implants per 100 implant-years, with an estimated 10-year survival of 83% to 85%.7

Positron emission tomography is an advanced imaging tool for diagnosis, staging, and restaging of breast carcinoma. However, fludeoxyglucose F18 uptake in infection and inflammation is not unexpected because fludeoxyglucose F18 is not a cancer-specific tracer. It has been reported that fludeoxyglucose F18 uptake in the breast can be caused by infectious or inflammatory mastitis that mimics malignant disease.8

As reported by Hardt et al,9 a retained capsule is a reservoir of implant-related foreign material that can calcify or lead to a persistent serous effusion. Foreign-body granulomatous reaction to silicone in lymph nodes is often confused with carcinoma recurrence.10

Return to Quiz Case.

Submissions

Due to the overwhelmingly positive response to the Image of the Month, the Archives of Surgery has temporarily discontinued accepting submissions for this feature. Requests for submissions will resume in January 2011. Thank you.

Correspondence: Emad Kandil, MD, Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA 70112 (ekandil@tulane.edu).

Accepted for Publication: May 1, 2009.

Author Contributions:Study concept and design: Alabbas and Kandil. Acquisition of data: Wassef, Chiu, and Kandil. Analysis and interpretation of data: Wassef and Kandil. Drafting of the manuscript: Wassef. Critical revision of the manuscript for important intellectual content: Chiu, Alabbas, and Kandil. Administrative, technical, and material support: Alabbas and Kandil. Study supervision: Kandil.

Financial Disclosure: None reported.

Rohrich  RJAdams  WP  JrBeran  SJ  et al.  An analysis of silicone gel-filled breast implants: diagnosis and failure rates. Plast Reconstr Surg 1998;102 (7) 2304- 2309
PubMed
Adams  WP  JrRobinson  JB  JrRohrich  RJ Lipid infiltration as a possible biologic cause of silicone gel breast implant aging. Plast Reconstr Surg 1998;101 (1) 64- 71
PubMed
Beekman  WHScot  MGTaets van Amerongen  AHHage  JJMulder  JW Silicone breast implant bleed and rupture: clinical diagnosis and predictive value of mammography and ultrasound. Ann Plast Surg 1996;36 (4) 345- 347
PubMed
Ahn  CYShaw  WW Regional silicone-gel migration in patients with ruptured implants. Ann Plast Surg 1994;33 (2) 201- 208
PubMed
Hughes  KCCalabretta  AMHirai  TManders  EK Unusual masses found within ruptured silicone gel breast prostheses. Plast Reconstr Surg 1997;100 (2) 525- 528
PubMed
Baack  BRWagner  JD Silicone gel breast implant rupture presenting as a fluctuant back mass after latissimus dorsi breast reconstruction. Ann Plast Surg 2003;51 (4) 415- 418
PubMed
Hölmich  LRFriis  SFryzek  JP  et al.  Incidence of silicone breast implant rupture. Arch Surg 2003;138 (7) 801- 806
PubMed
Bakheet  SMPowe  JKandil  AEzzat  ARostom  AAmartey  J F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med 2000;25 (2) 100- 103
PubMed
Hardt  NSYu  LLaTorre  GSteinbach  B Complications related to retained breast implant capsules. Plast Reconstr Surg 1995;95 (2) 364- 371
PubMed
Brown  SLSilverman  BGBerg  WA Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis. Lancet 1997;350 (9090) 1531- 1537
PubMed

Figures

Place holder to copy figure label and caption
Figure 1.

Computed tomography of the chest showing a left subpectoral mass. R indicates right; L, left.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Positron emission tomography of the chest showing increased intensity around the implant. R indicates right; L, left.

Graphic Jump Location

Tables

References

Rohrich  RJAdams  WP  JrBeran  SJ  et al.  An analysis of silicone gel-filled breast implants: diagnosis and failure rates. Plast Reconstr Surg 1998;102 (7) 2304- 2309
PubMed
Adams  WP  JrRobinson  JB  JrRohrich  RJ Lipid infiltration as a possible biologic cause of silicone gel breast implant aging. Plast Reconstr Surg 1998;101 (1) 64- 71
PubMed
Beekman  WHScot  MGTaets van Amerongen  AHHage  JJMulder  JW Silicone breast implant bleed and rupture: clinical diagnosis and predictive value of mammography and ultrasound. Ann Plast Surg 1996;36 (4) 345- 347
PubMed
Ahn  CYShaw  WW Regional silicone-gel migration in patients with ruptured implants. Ann Plast Surg 1994;33 (2) 201- 208
PubMed
Hughes  KCCalabretta  AMHirai  TManders  EK Unusual masses found within ruptured silicone gel breast prostheses. Plast Reconstr Surg 1997;100 (2) 525- 528
PubMed
Baack  BRWagner  JD Silicone gel breast implant rupture presenting as a fluctuant back mass after latissimus dorsi breast reconstruction. Ann Plast Surg 2003;51 (4) 415- 418
PubMed
Hölmich  LRFriis  SFryzek  JP  et al.  Incidence of silicone breast implant rupture. Arch Surg 2003;138 (7) 801- 806
PubMed
Bakheet  SMPowe  JKandil  AEzzat  ARostom  AAmartey  J F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med 2000;25 (2) 100- 103
PubMed
Hardt  NSYu  LLaTorre  GSteinbach  B Complications related to retained breast implant capsules. Plast Reconstr Surg 1995;95 (2) 364- 371
PubMed
Brown  SLSilverman  BGBerg  WA Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis. Lancet 1997;350 (9090) 1531- 1537
PubMed

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles