26 octobre, 2006 14:11

Monitoring the axilla in patients with silicone gel implants.

Department of Plastic Surgery, New York Hospital, Cornell Medical Center, NY 10021, USA.

Migration of silicone beyond the breast implant capsule may occur as a result of silicone bleed, leak, or rupture, and it may indicate failure of implant envelope integrity. We report a series of 23 patients with silicone implants who had axillary lymph node biopsies for palpable masses. Group 1 (n = 15) had biopsies performed an average of 6 years following aesthetic augmentation, and Group 2 (n = 8) had biopsies performed an average of 5 years after mastectomy reconstruction. All biopsies demonstrated foreign body reaction consistent with silicone migration. Five patients in Group 1 and two in Group 2 also had breast cancer detected by the axillary biopsy. Evaluation of the axilla utilized a combination of one or more techniques, including mammography, ultrasonography, magnetic resonance imaging, and fine-needle aspiration. We conclude that (1) routine evaluation of the axilla is mandatory in all patients with silicone breast implants; (2) an algorithmic approach in diagnosing axillary masses may be helpful, especially in augmentation patients; and (3) axillary masses detected by clinical examination or other means must be biopsied, even in the face of negative screening studies, because breast cancer may be coincidental with a silicone granuloma.