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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31821744d5
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Spectrum of Imaging Findings in the Silicone-Injected Breast

Leibman, A. Jill M.D.; Misra, Monika M.D.

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Department of Radiology; Jacobi Medical Center, and; Albert Einstein College of Medicine; Bronx, N.Y.

Correspondence to Dr. Leibman; Department of Radiology; Jacobi Medical Center; 1400 Pelham Parkway South; Bronx, N.Y. 10461; ajleibman@pol.net

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Sir:

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Silicone injection for breast augmentation was commonly performed in the 1960s. This procedure was subsequently abandoned and replaced by silicone breast prostheses. Non–medical grade silicone breast injection for augmentation is still being performed in the United States, Asia, and South America. Familiarity with the associated imaging findings is important for mammographic interpretation and surgical management.

The presence of injected silicone may first be discovered on mammography. High-density silicone granulomas are the hallmark of silicone-injected breasts (Fig. 1).

Fig. 1
Fig. 1
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Technically, mammography may be difficult to perform in patients who have undergone silicone injection for augmentation. Compression of the breasts is limited because the silicone-injected breast increases in thickness. Penetration of the silicone-injected breast requires increased radiation exposure.

Several mammographic patterns can be seen on mammography, including macronodular, micronodular, and mixed patterns.1 Silicone granulomas with calcified rims may develop. Another mammographic appearance is a single conglomerate dense mass. Occasionally, an implant will be placed in the silicone-injected breast that further obscures breast tissue. Differentiation of injected silicone from extracapsular rupture of a silicone implant may be challenging. Extracapsular silicone from breast implant rupture usually presents mammographically as larger, rounder globules of silicone that are less numerous compared with injected silicone.

A variety of postsurgical changes related to treatment by subcutaneous mastectomy or reduction mammaplasty may be evident on mammography. After subcutaneous mastectomy, residual silicone may still be evident (Fig. 2). In all cases, a significant amount of breast tissue is obscured by the silicone, and it is virtually impossible to detect malignancy on mammography.

Fig. 2
Fig. 2
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Mammography detects silicone lymphadenitis as enlarged, very dense nodes indistinguishable from lymph node involvement with breast cancer metastasis or other metastatic tumors. Silicone migration into the abdomen may be apparent on mammography.

The sonographic appearance of free silicone in the breast was described by Harris et al. as a “snowstorm” appearance that obscures the posterior breast tissue.2 Chest computed tomography images the breasts and may identify injected breast silicone (Fig. 3). Multiple, round, dense nodules are evident in the silicone-injected breast on computed tomographic scanning.

Fig. 3
Fig. 3
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Magnetic resonance imaging findings include multiple masses of low signal intensity on T1-weighted images.3 Because of the differential magnetic resonance imaging properties of injected silicone and breast cancer, magnetic resonance imaging may also incidentally detect breast cancer obscured on mammography by dense overlying silicone (Fig. 4).4

Fig. 4
Fig. 4
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Management of the silicone-injected breasts is not standardized. Treatment regimens include bilateral subcutaneous mastectomy with placement of subpectoral implants, unilateral subcutaneous mastectomy, or simple mastectomy.5 Overlap of symptoms and clinical findings may make diagnosis of breast cancer extraordinarily difficult in the silicone-injected breast.

Medical grade injected silicone for breast augmentation was abandoned in the United States many years ago. Patients continue to undergo non–medical grade silicone injection for breast augmentation and may present to plastic surgeons for treatment. Evaluation using various imaging modalities enhances surgical evaluation and management of the silicone-injected breast. Magnetic resonance imaging may be most helpful in excluding underlying breast cancer.

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

A. Jill Leibman, M.D.

Monika Misra, M.D.

Department of Radiology

Jacobi Medical Center, and

Albert Einstein College of Medicine

Bronx, N.Y.

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REFERENCES

1. Scaranelo AM, de Fátima Ribeiro Maia M. Sonographic and mammographic findings of breast liquid silicone injection. J Clin Ultrasound 2006;34:273–277.

2. Harris KM, Ganott MA, Shestak KC, Losken HW, Tobon H. Silicone implant rupture: Detection with US. Radiology 1993;187:761–768.

3. Caskey CI, Berg WA, Hamper UM, Sheth S, Chang BW, Anderson ND. Imaging spectrum of extracapsular silicone: Correlation with US, MR imaging, mammographic, and histopathologic findings. Radiographics 1999;19: S39–S51.

4. Cheung YC, Su MY, Ng SH, Lee KF, Chen SC, Lo YF. Lumpy silicone-injected breasts: Enhanced MRI and microscopic correlation. Clin Imaging 2002;26:397–404.

5. Parsons RW, Thering HR. Management of the silicone-injected breast. Plast Reconstr Surg. 1977;60:534–538.

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