Many of the pathologies that confront mastologists involve a resolution that warrants little to no discussion. The same is not true when patients consult after having allowed themselves to undergo liquid silicone injections into their breasts. As Prats Esteve pointed out a decade ago (Prats Esteve, Rev Senología y Patol Mam 16(2):43–44, 2003), the same three fundamental questions must be asked: How could this have happened? What are the risks to these women? What is the recommended action?
Although the US Federal Drug Administration (FDA) never authorized the use of liquid silicones in mastology (Food and Drug Administration. Current and Useful Information on Collagen and Liquid Silicone Injections. FDA Backgrounder, BG91-2.0, 1991; Physicians to stop Injecting Silicone for Cosmetic Treatment of Wrinkles. Food and Drug Administration. Press Release 11/07/1992; 92–95), they still are used in practice. The unfortunate reality is that the practice of silicone breast injections can lead to pathology that, albeit uncommonly, can endanger a patient’s life.
Imaging is required when there is silicone in the breast, whether by direct injection or leakage from a breast prosthesis. Moreover, silicone can migrate beyond the breast, into the axilla, chest wall, and beyond, into other anatomical areas like the mediastinum. The surgeon must try to remove all the silicone – which may be unlikely if it has spread. Subsequent identification of silicone remnants does not invalidate or belittle what has been achieved, since “curing” the pathology faced during surgery must be the prevailing goal; and silicone remnants may remain asymptomatic indefinitely.
Axillary adenopathies Axillary images Mammography Mastologist Sentinel ganglion Breast cancer Subcutaneous mastectomy
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