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Breast-nonmalignant
Inflammatory / infectious
Silicone implants-breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 10 April 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Important to document gross and histologic findings associated with implant related specimens
Terminology
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Epidemiology
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Sites
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Etiology
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Clinical features
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● Implants are used for breast construction post-mastectomy or for breast augmentation; consist of elastomer shell filled with silicone gel
● Do not cause systemic disease, but can leak and rupture, causing local scarring, infection and disfigurement
● Ruptures can cause intrapulmonary and cutaneous siliconomas (Breast J 2009;15:496, Clin Exp Dermatol 2009;34:e99)
● Implant related infections are rare (Diagn Microbiol Infect Dis 2009;63:390)
● Recommended to photograph and describe surface of removed implant for possible litigation (Mod Pathol 2000;13:1050)
● Can chemically identify silicone inclusions with Raman spectroscopy (Mod Pathol 1999;12:714)
● Implant-associated mesenchymal tumors are rare, and most are fibromatoses (Hum Pathol 2009;40:1564)
● Associated with anaplastic large cell lymphoma adjacent to implants (Mod Pathol 2008;21:455, Arch Pathol Lab Med 2003;127:e115, Am J Surg Pathol 2008;32:1265, Diagn Pathol 2009 Apr 2;4:11)
Prognostic factors
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Case reports
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● 25 year old woman with capsular synovial metaplasia mimicking silicone leak of breast prosthesis (J Med Case Reports 2008;2:277)
● 48 year old woman with synovial metaplasia of periprosthetic breast capsule (Arch Pathol Lab Med 1994;118:249)
● 56 year old woman with follicular lymphoma and adjacent granulomatous response to foreign material next to silicone implant (Am J Surg Pathol 1995;19:712)
● Leaky implant associated with Kikuchi-Fujimoto disease (Arch Pathol Lab Med 1996;120:380)
● With pneumonitis and silicone in alveolar histiocytes after implant rupture (Ir J Med Sci 2010;179:141)
Treatment
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Clinical images
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Drawings
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Silicone implant
Gross description (Macroscopy)
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Micro description (Histopathology)
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● Chronic inflammatory response (plasma cells, B and T cells and foamy macrophages) with fibrotic capsule around the implant causing contracture of prosthesis (Aesthetic Plast Surg 2010 Mar 13 [Epub ahead of print])
● Lining cells may resemble synovium (synovial metaplasia, Mod Pathol 1994;7:310)
● Gel may seep through intact implant shells
● May have foreign body reaction with sinus tracts
● Numerous cystic spaces and vacuoles may exist where silicone dissolves during processing
Micro images
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Refractile silicone and giant cell reaction Polyurethane implant - Polyurethane
(arrow at doubly-refractile silicone) (arrow) and silicone (round globules)
Silicone mastitis
Silicone globules, giant cell inflammatory reaction, fibrosis
Capsular synovial metaplasia
Virtual Slides
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Foreign body reaction
Videos
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Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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Additional references
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● Am J Surg Pathol 1995;19:433, Mod Pathol 1999;12:706, Mod Pathol 1994;7:728, Hum Pathol 1985;16:19, eMedicine, Wikipedia
End of Breast-nonmalignant > Inflammatory / infectious > Silicone implants-breast
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