Extragenital lichen sclerosus of the breast and silicone breast implants

Lichen sclerosus of the breast (LSB) is an uncommon inflammatory dermatosis of an incompletely understood pathogenesis. Herein, we report the case of a 29-year-old female who developed LSB 23 years after a silicone breast implant. A diagnostic skin biopsy revealed the typical three-layered pathology of an atrophic epidermis with the loss of rete ridges and basal keratinocyte vacuolization, a subepidermal band of sclerosis, and a lichenoid infiltrate of lymphocytes beneath that band. We discuss the possible relationship between silicone breast implants and autoimmune disorders.

Silicone Breast Implant Coated with Triamcinolone Inhibited Breast-Implant-Induced Fibrosis in a Porcine Model

Cosmetic silicone implants for breast reconstruction often lead to medical complications, such as abnormally excessive fibrosis driven by foreign body granulomatous inflammation. The purpose of this study was to develop a silicone breast implant capable of local and controlled release of a glucocorticoid drug triamcinolone acetonide (TA) for the prevention of silicone-breast-implant-induced fibrosis in a Yorkshire pig model (in vivo). Implants were dip-coated in a TA solution to load 1.85 μg/cm2 of TA in the implant shell, which could release the drug in a sustained manner for over 50 days. Immunohistochemical analysis for 12 weeks showed a decline in tumor necrosis factor-α expression, capsule thickness, and collagen density by 82.2%, 55.2%, and 32.3%, respectively. Furthermore, the counts of fibroblasts, macrophages, and myofibroblasts in the TA-coated implants were drastically reduced by 57.78%, 48.8%, and 64.02%, respectively. The TA-coated implants also lowered the expression of vimentin and α-smooth muscle actin proteins, the major profibrotic fibroblast and myofibroblast markers, respectively. Our findings suggest that TA-coated silicone breast implants can be a promising strategy for safely preventing fibrosis around the implants.

Autoimmune / Inflammatory Syndrome Induced by Adjuvants (Asia Syndrome) Associated with Silicone Breast Implant Rupture

Background: Autoimmune/inflammatory syndrome (ASIA) constitutes a set of related immune mediated diseases that share a common clinical picture and a history of a previous exposure to an adjuvant agent. From a clinical standpoint, patients present with none specific manifestations such as myalgia, arthralgia, chronic fatigue and dry mouth as well as neurological manifestations such as cognitive disturbances, memory loss and neurologic disabilities. .Case presentation: A previously healthy 25-year-old patient who underwent breast augmentation 3 years ago, with an asymptomatic rupture of the silicone breast implant, presented with three major criteria of ASIA, and improved after bilateral implant removal. She also had pleuritis and pericarditis, rarely described in such disease. A literature review on complications related to breast implants, their questionable relationship to the onset of autoimmune pathologies, and basic aspects of the diagnosis and management of ASIA was carried out. Conclusion: The silicone presented in breast implants should be considered as an adjuvant, with the potential to cause chronic stimulation to the immune system. This can lead to systemic manifestations that can be severe in patients genetically predisposed and potentially not reversible even after surgical removal of the implants. When facing patients with breast implants and systemic clinical symptoms, lymph node disorders, neurological manifestations, or serositis as in the case presented, without other defined etiology, the possibility of ASIA should be considered in the differential diagnosis.

Progressive silicone lymphadenopathy post mastectomy and implant reconstruction for breast cancer

A 56-year-old woman with a 12-year history of recurrent triple-negative invasive carcinoma of the breast presented with progressive enlargement of lymph nodes in the setting of established rupture of the ipsilateral silicone breast implant. Although this was proven to be benign on cytology, its progressive nature led to repeated core biopsies for histology, which were necessary given the high-risk nature of triple-negative breast cancer and the multiple proven previous recurrences. The histology demonstrated features of silicone deposits without evidence of malignancy. This case demonstrates the dilemma in surveillance of high-risk patients with breast cancer who have had previous silicone lymphadenopathy.