IMAGE OF THE WEEK 2012

WEEK 7

SILICONE GRANULOMAS OF THE BREAST

Silicone injection for breast augmentation is still commonly practice in Asia. Medical-grade silicone gel or oil is ubiquitous in the environment and probably almost everyone who has had intravenous injection or infusion in hospital would have been exposed to a small silicone which is used to lubricate the tubing or syringe. However, prolonged exposure of medical-grade silicones such as those injected for breast augmentation can stimulate a non-specific foreign body response, with macrophage invasion, giant cell granulomas formation and eventually scarring (Figure 1).

The granuloma formation resulted in a lumpy or nodular breast and can occurred between 3 to 20 (mean 8.4) years from time of injection. Besides lumps, 21% may have associated mastitis and 16% dermatitis.

Radiologically, the breast appeared dense and nodular just like the shown in figure 1. There are diffuse, multiple dense opaque nodules of various sizes throughout both breast tissue.

So far, 3 large-scale studies and 2 smaller ones have reported that women with implants may have up to 30% less incidence of breast cancer than expected statistically when matched with the general population. Blood taken from women with implants has been shown to kill breast cancer cells in tissue culture. With evidence from over 30 years time frame that silicone implants have been used, the risk of developing cancer from such implants can be said to be negligible, if not nil. However, although there is no evidence that silicone used in breast implants is carcinogenic in humans, direct exposure to the silicon gel or oil when they are injected into breast tissue is uncertain.

Perhaps the most significant concern with regards to breast implants or silicone injection into breast is the difficulty and as a result the delay in detection of breast cancer. The multiple dense granulomas make the breast nodular and difficult to differentiate from actual breast cancer which can occur among the granulomas.

The Society for Breast Imaging, the American Society of Plastic and Reconstructive Surgeons (ASPRS) and the American Cancer Society have drawn up guidelines in that a woman with breast implants should be on the same schedule of routine mammography as other women as follows,

1.    Baseline – At the earliest when aged 35 years

2.     Biannually – When aged 40-50 years

3.    Annually – When older than 50 years

Image and text contributed and prepared by

Mr Chong Chee Fui, Department of Surgery, RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.