The complications associated with silicone breast mammoplasty have been previously described in the medical literature. However, the potential thoracic manifestations are not well known. We report a case of a patient who presented with a left hilar mass and pulmonary nodule twenty-five years after bilateral silicone injection breast augmentation.
A 46-year-old asymptomatic female with no history of cigarette smoking or known exposures to carcinogens presented initially for breast reconstruction utilizing saline bag prosthesis. The preoperative chest radiograph revealed a left hilar density, a left lung nodule, and a pleural effusion (Figure 1). Twenty-five years previously, she underwent cosmetic, bilateral mammoplasty with direct liquid silicone injection. Workup of the thoracic abnormalities proved to be non-diagnostic, and subsequent thoracotomy was performed. Biopsies of the left hilar mass showed benign granulomatous response presumably to the silicone, which was also present in the hilar nodes. A wedge resection of the pulmonary nodule revealed thromboembolic vascular occlusion with silicone and an associated nodular pulmonary infarction. Eighteen months later, the patient presented with hoarseness and mild dyspnea on exertion. A repeat chest radiograph showed an enlarging left hilar mass (Figure 2). Fiberoptic bronchoscopy showed a newly paralyzed left vocal cord and a lobulated endobronchial lesion nearly completely occluding the left upper lobe orifice. Subsequent biopsies of this lesion revealed a small cell lung carcinoma. The patient received multiple courses of systemic chemotherapy but eventually succumbed to widespread extrathoracic metastases.
The potential health hazards of the silicone implant led to a ban of its use for augmentation mammoplasty by the Food and Drug Administration (FDA) in 1992 (1). A known complication of silicone breast augmentation is silicone lymphadenopathy, an infrequent and benign consequence of mammary augmentation utilizing either direct injection or bag-gel prosthesis technique (2,3). The majority of reported cases have involved axillary or supraclavicular nodes and had been considered an incidental finding without clear clinical significance (1,4). To our knowledge, only one other report has described hilar adenopathy as a consequence of either silicone injection or prosthesis placement, and no other report has described the development of a pulmonary nodule (5). Anecdotal case reports have described a possible link between silicone mammoplasty and connective tissue diseases (1). Malignant lymphomas have been reported in orthopedic patients with silicone metacarpophalangeal joint implants in association with silicone granulomas in lymph nodes, but whether silicone is the causative agent remains uncertain (6). According to a review of the possible health implications of silicone breast implants, there was no association between silicone mammoplasty and the subsequent development of breast carcinoma (1). To our knowledge, no other case report has described the subsequent development of a small cell lung carcinoma in the site of silicone lymphadenopathy.
This discovery in a non-smoking patient is suggestive of a causal relationship. Our observations in this case should stimulate further studies regarding potential sequelae of direct silicone migration.
J.A. De Olazabal, None.