Distant Migration of Multiple Siliconomas in Lower Extremities following Breast Implant Rupture: Case Report

Abstract

Siliconoma from ruptured breast implants has been reported in multiple body sites, including but not limited to the breast parenchyma, axillary lymph nodes, upper arm, and even lower leg. In this regard, we report a rare case of distant silicone migration to the lower extremities after traumatic breast implant rupture. A 55-year-old Asian woman who received bilateral augmentation mammoplasty 20 years ago presented with ruptured breast implants from a car accident 2 years earlier. Magnetic resonance imaging confirmed intracapsular and extracapsular rupture of the right breast implant, showing "linguine sign." We removed the bilateral breast implants and performed capsulectomy and bilateral reduction mammoplasty using inverted-T incisions. The implant was confirmed as a smooth, silicone gel-filled mammary implant of 125 cm3 by a Japanese manufacturer, Koken. During her regular follow-up outpatient visits, physical examination revealed 2.5- × 1.5-cm ill-defined, tender, subcutaneous nodules on both knees and 8.5- × 3.0-cm inflammatory changes in the inguinal area with persistent pain. Computed tomography showed no definite mass, but rather infiltrative, nonenhancing soft-tissue densities in the subcutaneous layers of the bilateral inguinal and knee areas. Surgical excision was performed, and pathologic findings confirmed variable vacuoles with foreign body reaction and fibrosis, consistent with siliconoma. It is important to acknowledge that siliconomas can be encountered in patients with ruptured breast implants, especially those manufactured decades ago. Our patient with masses as remote as the inguinal and knee areas is a prime example of how far siliconomas can migrate.