Silicone lymphadenopathy after silent Silicone breast implant rupture

Silicone breast implants have an elastomer silicone shell filled with viscous silicone gel. There is still debate about the possible occurrence of systemic complications of silicone prosthesis implantation. On the contrary, local complications, such as capsular contracture and breast implant rupture, are well documented. Implant rupture, which is often silent, results in either intracapsular or extracapsular leaking of the silicone gel. There have been sporadic reports of breast implant rupture with systemic silicon spread; however, mechanisms and consequences of systemic silicone migration are still poorly understood. Herein, we report the case of a 70 years old woman, who had idiopatic acute pericarditis with anterior pericardial thickening and modest pericardial effusion and concomitant evidence of silicone lymphadenopathy. Specifically, the patient, who had had bilateral breast augmentation with silicone implants for cosmetic purposes 35 years earlier, had bilateral breast implant rupture, ipsilateral both intra-mammarian and axillary reactive lymph nodes, and bilateral lymphadenopathy of the internal mammary chain. Ultrasounds showed that one of the axillary lymph nodes had a "snowstorm" appearance, which is considered a silicone signature. Following surgical breast prosthesis removal, there was complete resolution of both pericarditis and lymphadenopathy. This clinical report underscore the importance of both screening of silent ruptures and rapid surgical removal of failed implants|