A 34-year-old female patient came with complaints of cough for 4 months. She had no history of postnasal drip, nasal symptoms, fever, weight loss, or loss of appetite. She gave a history of prior breast implant surgery in childhood for cosmetic purposes. Otherwise, there were no major past medical or surgical diseases. General physical examination and respiratory examination were normal. Complete blood count, erythrocyte sedimentation rate, and other routine blood tests were normal. The chest radiograph showed homogeneous opacity in the right lower zone in the para-cardiac region mimicking a right lower zone consolidation [Figure 1]. HRCT of the thorax was performed to rule out complications of breast implants. HRCT however showed lungs to be normal with an intact breast implant in place [Figure 2]. The patient was treated with antihistamines and other symptomatic measures. She showed improvement with the same.
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Figure 1: Chest radiograph image showing homogeneous opacity in the right lower zone in the para-cardiac region
Figure 2: CT image showing the right breast implant with an intact capsule
DISCUSSION
Silicone breast implants have been used since the mid-20th century. They are pre-filled with elastomer which is gel-like, thick and sticky in consistency.[1] Their use is increasing in present times. It is mostly for cosmetic and for surgical reconstruction after mastectomy.[2] The tissue in contact with silicone can get chronically inflamed due to repeated leakage, leading to many adverse events.[1] In addition to this, complications due to the embolisation of silicone have also been reported.[3] Some of the common complications are rupture, tissue contracture due to fibrosis, migration of the implant, and other neurological complications. Pulmonary complications of breast implants include chemical pneumonitis, recurrent chest infections, embolisation, and interstitial lung disease due to autoimmune syndrome induced by adjuvants (ASIA).[4] ASIA is a cluster of conditions caused by exposure to substances with adjuvant activity. The common adjuvants that cause this are the ones present in vaccines and silicone prosthetic devices. The symptoms can be varied and include myalgia, arthralgia, fatigue, and neurological symptoms.[5] One case reported by Arora et al.[3] had a patient with silicone microembolisation to the lung present as interstitial lung disease. There have also been reports of pleuritic chest pain, cough, and dyspnoea due to pneumonitis with an intact capsule of breast implants.[4]
Magnetic resonance imaging (MRI), mammography, computed tomography (CT scan), and ultrasonography can be used to diagnose the above disorders associated with breast implants.[2] CT scan and MRI can both detect the implant structure, rupture, and health of surrounding tissue. However, the MRI technique has higher sensitivity and specificity as compared to CT.[6] Mammography is not very useful to assess the implant structure but can be useful to look at the surrounding tissue.[2] Ultrasonography can be more useful than mammography in assessing the integrity of the implant.[2] Most of the symptoms improve with the removal of implants except for autoimmune conditions. Studies have shown that autoimmune diseases can persist even after their removal.[4] Though our patient did not have any such complication relating to the implant, it did mimic one of the complications in radiology. It is also necessary that the above complications should be considered by the treating physician in any patient with breast implants who presents with respiratory symptoms.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Fireman E, Rosengarten D, Zelinger E, Kramer MR. Interstitial lung diseases associated with metal content in silicone breast implants:A case series. Sarcoidosis Vasc Diffuse Lung Dis 2018;35:381–9.
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3. Arora A, Inaty H, Mukhopadhyay S. Chronic pulmonary silicone embolism related to saline breast implants. Ann Am Thorac Soc 2016;13:139–40.
4. Johansen NJ, Hilberg O, Løkke A. 21-year-old silicone breast implants causing recurrent pneumonia, chest pain and coughing. Respir Med Case Rep 2020;29:101025.
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