Postoperatively, the patient received 4 units of packed red blood cells due to significant blood loss during the hematoma removal, but otherwise recovered well with no acute events or evidence of hemodynamic instability. At follow-up 1 month later, the patient was doing well, with no further complaints or complications (Fig. 4).
A literature review was performed to find reported cases of distant silicone migration following breast implant rupture.5–23 Descriptive statistics were calculated using the present case, and all but 1 reported case for which individual patient data were not provided.8 The year of initial silicone implant placement was either reported for each case or estimated by year of article publication.
In addition to our own case report, a total of 20 patients from 19 case reports were found. The qualitative and quantitative results of this review can be seen in Table 1 (http://links.lww.com/PRSGO/A839). Median age was 48 years (range, 21–76). Median time between initial breast augmentation and eventual presentation was 10 years (range, 1–30 years). Sites of migrated silicone included arm/forearm (n = 11), thoracic cavity (n = 4), abdominal wall (n = 3), legs (n = 2), and back (n = 1). A total of 67% of patients had documented trauma to the chest before presentation.
This case exemplifies the range of complications seen after silicone implant rupture and the importance of prompt diagnosis and intervention. The delay (3 years) between documented chest trauma and surgical intervention likely allowed the corresponding hematoma to expand and incorporate. It is also possible that the initial silicone extravasation resulted in a chronic lymphocytic granulomatous reaction, which then lead to recurrent acute-on-chronic hematoma. This likely necessitated the significantly more invasive procedure requiring blood transfusion. Although surgeons must promptly diagnose and treat implant rupture, this case also argues for patient education; patients should be educated on the signs and symptoms of implant rupture and should return to care if observed.
It should be noted that many of the implants involved in this series were from the 1970s to early 1990s, before the evolution of highly cohesive implants. It will be interesting to see if the trends in implant cohesion correlate with rates of distant silicone migration following implant rupture.
The extravasation of silicone into the right arm in this case, and the array of distant silicone sites presented in the literature review, serves as a reminder to complete a comprehensive physical examination when implant rupture is suspected. The distant sites of extravasation may not be captured by diagnostic imaging and could be easily neglected without careful examination.
This case emphasizes the importance of prompt treatment and diagnosis of silicone implant rupture by demonstrating the complications with delay in care. The distant migration of silicone presented in this case, and literature review, illustrates the need for a thorough physical examination when ruptured implants are suspected.
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