Silicone breast implant-induced lymphadenopathy: 18 Cases

Background: There is renewed concern regarding the adverse effects of silicone breast implants, particularly regarding implant rupture. Silicone leak can spread to regional lymph nodes, and remote organs, sometimes mimicking malignancy. The aim of this study was to determine the clinical and radiologic features, pathologic findings, and outcome associated with silicone-induced lymphadenopathy in patients with silicone breast implants. Methods: Retrospective review of cases of silicone-induced lymphadenopathy after breast implant encountered at Mayo Clinic Rochester between 1998 and 2008. Results: We identified 18 cases of silicone-induced lymphadenopathy (axillary, supraclavicular, internal mammary, and mediastinal). Fifteen patients had breast reconstruction and 3 breast augmentation. Most patients experienced symptoms. One patient had pulmonary opacities, retroperitoneal lymphadenopathy, hypercalcemia, and confirmed silicone in the thyroid, and the omentum. Imaging included mammography, chest CT, breast MRI and PET scan. Lymph node biopsies and/or breast implant removal confirmed the diagnosis with characteristic granulomatous inflammation and giant cell reaction and/or implant rupture. Conclusions: Silicone-induced lymphadenopathy can be confused for malignancy or recurrent breast cancer in patients with breast implants. Silicone breast implant ruptures are relatively uncommon, but are under-recognized. Silicone usually migrates to the axillary lymph nodes but may migrate to other lymph nodes as well as extranodal sites.