Algorithm for Treating Granulomas Produced by Silicones Injected to Modify Body Contour
The use of injected liquid silicones to reshape soft tissues and increase their volume is a controversial health issue. Introducing industrial silicones, oils or paraffin into the body, for aesthetic or cosmetic purposes, produces an immunological reaction that can trigger the formation of multiple granulomas or siliconomas in the dermis. It also may trigger the onset of autoimmune diseases and diseases caused by the embolization of silicone particles that are hematogenously directed toward various organs, including the liver, spleen, kidneys, brain, pancreas, adrenal glands, bone marrow, and lung. The substance that migrates to the lung causes chronic interstitial pathology and can trigger respiratory failure followed by death. Migration from breast tissue to lymph nodes causes a reaction that may present as axillary lymphadenopathy and must be differentiated from malignant metastasis (Schenone et al. , Revista Argentina de Cirugía Plástica (1):0113–0120, 2018). Such manifestations may become manifest immediately after the administration of silicone, or may be delayed, for anywhere from a few days, weeks, or months to over a decade postinjection, such manifestations typically the product of a foreign-body immune reaction.
It is important to point out that mammary siliconomas impede adequate clinical examinations, because inflammatory reactions in mammary parenchyma and in pectoralis major muscle make it difficult for evaluations by mammography, mammary ultrasound, or magnetic resonance imaging (MRI). This places such patients at risk for the delayed detection of breast cancer. Generally, dissection of the affected areas is required, which can produce significant tissue loss (Price et al. Am J Forensic Med Pathol 27:97–102, 2006).
Treatment is individualized and related to the mechanisms involved. However, it often requires the surgical removal of the silicone and any affected tissue and sometimes even the incorporation of immunosuppressive drugs. However, if dissemination has occurred, dissection will not be enough to achieve symptom resolution. In patients in whom the course of disease has evolved to the point of autoimmune disease, immunomodulatory treatment should be started immediately. Untreated siliconomas can cause skin induration, local tissue destruction, ulceration, scarring, deformity, and neural damage.
KeywordsSiliconomas Autoimmunity Embolization
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