Discussion Author: Ralph H Pickard
Silicone Granulomas of the Breast
Silicone breast implants have a controversial history and are no longer approved for use by the Food and Drug Administration. They consisted of a flexible silicone rubber outer envelope that was filled with a silicone gel. Anecdotal reports of complications related to silicone breast implants are numerous including associations with connective tissue disorders such as scleroderma and rheumatoid syndromes.
Indisputable complications of all types of breast implants include surgically related complications such as bleeding and infection. Later in the life of an implant, the predominant complications include capsular contracture and implant rupture.
The cause of these complications remains elusive although some interesting things have been demonstrated. For instance, the gel inside the silicone implant is in a polymerized form. Unpolymerized silicone can seep through an intact silicone envelope into the surrounding tissue. It is theorized that this unpolymerized silicone stimulates the fibrotic reaction responsible for capsular contraction. Silicone seeping through an intact envelope, as well as implant rupture, are associated with granuloma formation.
Silicone granulomas are very variable in mammographic appearance. They can range from single or multiple well-defined nodular masses of varying size to ill-defined, irregularly shaped densities. They are usually very dense (usually more dense than a similarly sized malignancy). It is important to obtain a good surgical history regarding previous breast implants and, of course, comparison with old films is crucial. They are often biopsied because of their suspicious appearance.
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