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In silicone granulomatous disease, lymph node excision may be indicated

In an usual presentation of bilateral breast implant rupture leading to severe locoregional silicone granulomatous lymphadenopathy, researchers found surgical excision of encroaching lymph nodes brought symptom relief.

The researchers described the case of a 33-year-old woman who presented with bilateral breast pain 5 years after submuscular augmentation mammoplasty. No history of trauma was reported. An MRI revealed bilateral extracapsular implant rupture with bilateral internal mammary and axillary lymphadenopathy. The patient opted for explantation and total capsulectomy, as well as a selective excision of palpably swollen bilateral level 1 axillary lymph nodes. A fibrous pseudocapsule with silicone material throughout, as well as silicone lymphadenopathy with no evidence of malignancy, were identified through histology.

At 4 months postoperatively, the patient presented with a tender left supraclavicular mass and complaints of intermittent glove-like paresthesiae of her left hand. MRI revealed bilateral lymphadenopathy of the axillae and supraclavicular regions and one enlarged mediastinal node. The patient underwent excision biopsy of five left-sided supraclavicular nodes to rule out lymphomatous malignancy. Although the histology revealed silicone lymphadenopathy, there was no evidence of malignancy, according to the researchers.

The patient re-presented 4 months later with a tender left supraclavicular mass. To exclude lymphoproliferative change, the patient underwent excision biopsy of three left-sided supraclavicular nodes and one right-sided supraclavicular node. By 3 weeks after surgery, the patient presented with tender bilateral supraclavicular swelling and numbness in both arms.

Changes in sensation and decreased power in C4-T2 distribution were revealed through examination, as well as positive Adson’s and Roos’ provocative tests for thoracic outlet compression. The patient underwent targeted excision of enlarged lymph nodes proximal to the brachial plexus.

The patient presented with symptoms of thoracic outlet compression on the left side at 6 months postoperatively. Following further discussion by the multidisciplinary team, she underwent an en block level 5 lymph node clearance. Four months later, she regained normal sensation, power and range of motion, with no signs of lymphedema, according to the researchers.

The researchers concluded that there is currently no consensus on silicone granulomatous disease management and proposed that indications for surgical excision should include biopsy, in order to exclude malignancy and symptomatic relief in cases where medical management was unsuccessful. – by Jennifer Byrne

Disclosure: The researchers report no relevant disclosures.