Contralateral Axillary Lymph Node Enlargement in a Woman with Silent Silicone Breast Implant Rupture ۳۰ Years After Breast Cancer Diagnosis: A Lesson to Be Learnt

Background: Silicone lymphadenopathy is a recognized complication ofsilicone implant rupture. It occurs when silicone droplets migrate from breastimplants to lymph nodes, resulting in the formation of granulomas (known assiliconoma) and lymph node enlargement. The ipsilateral axillary lymph nodes aremost commonly involved but it can also affect contralateral axillary,supraclavicular, internal mammary and mediastinal lymph nodes.Case presentation: A ۶۰-year-old woman with a history of left breast cancerwho had undergone modified radical mastectomy (MRM) followed by left breastreconstruction with implant (۳۰ years ago) presented with right axillary lymphnodes enlargement. An excisional biopsy of the two larger lymph nodes wasperformed to rule out malignancy. Pathologic examination showed features ofsilicone lymphadenopathy. Further examination with Ultrasound and MRIconfirmed breast implant rupture.Conclusion: Silicone lymphadenopathy following breast augmentation andreconstruction primarily affects the ipsilateral axillary nodes. Contralateral lymphnode involvement is rare and may occur several years after breast cancer diagnosisand can be the first sign of breast implant rupture. Although, the need to excludemalignancy in such cases is of outmost importance, silicone lymphadenopathyshould also be considered in the differential diagnosis.

Keywords:

Breast carcinoma , silicone lymphadenopathy , contralateral axillary lymphadenopathy