Silicone has been used in surgery for over 40 years in breast augmentation. It is composed of dimethylsiloxane polymers, which can result in differing properties according to the variation in their chain lengths and cross-links. Despite its initial reputation as a biologically inert material, it has been related with numerous complications including local and systemic granulomatous inflammatory reactions affecting breast tissue, lymph nodes, joint capsules, heart, liver, and kidneys. Silicone lymphadenopathy involving axillary lymph nodes is an uncommon complication of augmentation mammaplasty.[2
Silicone particles can migrate through tissues by two distinct mechanisms. The first, following rupture or erosion of a silicone-containing surface and secondly, through continued leakage through an intact surface. The risk of rupture or leakage increases with increasing age of the implant, the site of implantation (retroglandular), the presence of local tissue contractures or symptoms and the type of implant. The average age at rupture varies between studies, but is in the region of 10 to 13 years and it is best diagnosed by MRI. Rupture is usually a harmless complication, which only rarely progresses and becomes symptomatic. When leakage does happen, silicone can cause fibrosis and foreign body reaction, especially when combined with certain fatty acids, resulting in pain and contractures. Once silicone particles have breached the confines of their prosthesis, they may be dispersed through any fibrotic reaction to regional lymph nodes by macrophages in the reticuloendothelial system. The granulomatous reactions may present as lymphadenopathy and, when present in the axilla, malignancy of the ipsilateral breast needs to be excluded.[2
The presence of silicone droplets in lymph nodes of patients with breast implants suggests that the transit of various elements, either synthetic or biologic, from breast tissue to lymph nodes via lymphatic channels may have a significant passive component. This passive component may be a crucial determinant in the metastatic process. Silicone migration from breast implants to lymph nodes may therefore represent a model that could be useful in understanding the passive component of metastasis in breast cancer.[7
The clinical importance of silicone lymphadenopathy has several different facets. In patients who have had post-mastectomy reconstructive surgery using silicone gel breast implants, the differential diagnosis of regional lymph node enlargement should include metastatic breast cancer, as well as silicone lymphadenopathy. In most individuals, who have had cosmetic surgery for breast augmentation, one must also recognize the potential for adverse health effects of silicone migration to regional lymph nodes. The association between silicone breast prostheses and systemic diseases is a highly controversial issue. Till now, most epidemiologic studies, found no association between breast implants and a variety of connective tissue diseases, despite the fact that Brown et al
. have published a statistically significant link between ruptured silicone gel implants and fibromyalgia, as well as other autoimmune diseases.[8
] On the other hand, there are numerous reports of symptoms in women with breast implants, including myalgia, arthralgia, fatigue and sleep disorders, but there is no adequate evidence of such a relation in the literature. Furthermore, the role of silicone in the development of lymphoma deserves mention, since there are several case reports describing primary breast lymphoma in patients with silicone gel breast implants, as well as patients with coexistent silicone lymphadenopathy and lymphoma in the same lymph node.[6
In conclusion, silicone lymphadenopathy is a rare complication of procedures involving insertion of silicone-containing prostheses. This case study highlights the fact that patients need a thorough preoperative evaluation with histologic confirmation of the non-malignant nature of regional lymphadenopathy and reinforces the need to employ a high index of clinical suspicion, in order to exclude malignancy, without leading patients to dangerous overtreatment regimes.