Hidden breast cancer after breast augmentation, not presenting as a hypoechoic mass lesion, diagnosed using colour Doppler ultrasound

The main concern after breast augmentation with silicone injection is that silicone granulomas make it difficult to detect breast cancer. A case of breast cancer was diagnosed using colour Doppler ultrasound (CD) to detect an non-palpable mass not presenting as a hypoechoic mass lesion. An 83-year-old woman was incidentally found to have a lesion in her right breast, which was injected with silicone, showing 18F-fluorodeoxyglucose (FDG) uptake; the lesion was suspected to be breast cancer or silicone granuloma. A mass at the FDG uptake site was not detected on ultrasonography (US); however, observation using CD revealed a slightly hypoechoic area with hypervascularity. Core needle biopsy showed invasive ductal carcinoma. Patients in whom US does not reveal lesions after breast augmentation with silicone injection should undergo CD to detect hypervascularised tissue. To prevent false-negative biopsy results, CD is essential to detect cancer at suspected sites.

MRI Features of Free Liquid Silicone in the Transgender Female Breast

Objective To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management. Methods This study was IRB–approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using two-tailed Fisher exact and Student’s t test. Results Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4–12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed. Conclusion MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.

A Rare Case of Pulmonary Restrictive Syndrome after Liquid Silicone Injection: The Role of the Plastic Surgeon

Despite being especially used in its solid form, silicone is still injected as a liquid filler for breast contouring in many countries. Here, we present a rare case of a woman with silicone pneumonitis and extended breast scarring after breast silicone injection. Because of evidence of a restrictive syndrome due to the thoracic extensive scarring tissue and the high demand of oxygen therapy, as jointly agreed with the pulmonologists, we decided to perform a surgical asportation of the scarring tissue and covering with microsurgical flap. We chose the deep inferior epigastric perforator flap mainly because of the large amount of skin that is possible to use, the good skin texture matching, and the possibility of double team working without changing patient’s position.

Case Series: Hypercalcemia From Granulomatous Silicosis Developing After COVID-19 Infection

Hypercalcemia is one of the most commonly encountered laboratory abnormalities in clinical medicine. Various causes have been well established. However, it is likely that the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be a newly found cause of this frequent finding, especially amongst those with a history of cosmetic surgery, specifically by means of silicone injection. In this case series, we describe 2 patients presenting with symptomatic hypercalcemia likely from their prior silicone injections. Interestingly, each patient only developed symptoms of hypercalcemia following infection with SARS-CoV-2.

Common Challenges and Solutions Associated with the Preparation of Silicone-Injected Human Head and Neck Vessels for Anatomical Study

Neuroanatomy laboratory training is crucial for the education of neurosurgery residents and medical students. Since the brain is a complex and three-dimensional structure, it is challenging to understand the anatomical relationship of the cortex, internal structures, arteries, and veins without appropriate adjuncts. Several injection agents—including the inks/dyes, latex, polyester, acrylic resins, phenol, polyethylene glycol, and phenoxyethanol—have been explored. Colored silicon injection protocols for the head and neck vessels’ perfusion have greatly aided the study of neuroanatomy and surgical planning. This report presents a colored silicone injection method in detail, and also highlights the technical shortcomings of the standard techniques and workarounds for common challenges during 35 human cadaveric head injections. The human cadaveric head preparation and the coloring of the head vessels are divided into decapitation, tissue fixation with 10% formalin, the placement of the Silastic tubing into the parent vessels, the cleaning of the vessels from clots, and the injection of the colored silicone into the vessels. We describe the technical details of the preparation, injection, and preservation of cadaveric heads, and outline common challenges during colored silicone injection, which include the dislocation of the Silastic tubing during the injection, the injection of the wrong or inappropriate colored silicone into the vessel, intracranial vessel perforation, the incomplete silicone casting of the vessel, and silicone leakage from small vessels in the neck. Solutions to these common challenges are provided. Ethyl alcohol fixed, colored human heads provided the long-term preservation of tissue, and improve the sample consistency and preservation for the teaching of neuroanatomy and surgical technique.

Metaplastic Carcinoma with Mesenchymal Differentiation in Augmented Breast using Liquid Silicone Injection: A Case Report

The relationship between the use of liquid silicone for breast augmentation and carcinogenesis remains undetermined due to limited data reported, especially regarding its risks for acquiring cancer. We documented a case of an 81-year-old woman who presented with bilateral enlarging breast masses with a known history of breast augmentation using liquid silicone. On microscopic examination, the malignancy showed both mesenchymal and epithelial components in a background of stromal changes related to liquid silicone. Based from morphology and immunohistochemistry studies (p63, CK, HMW-CK, and CK5/6, CD34, and BcL-2), this case was signed out as metaplastic carcinoma with mesenchymal differentiation. This rare case of metaplastic carcinoma with mesenchymal differentiation coexisting with liquid silicone, provides evidence supporting the link between cancer development and siliconomas.

Computer-Aided Design and Additive Manufacturing of Custom Silicone Prosthetic Finger

Finger and partial finger amputations are one of the most frequently encountered forms of partial hand loss. Most of these amputees can benefit from prosthetic fingers, which should be both functional and aesthetic, to enhance rehabilitation by permitting a more normal professional and social life. Custom prosthetic fingers perform better than off-the-shelf ones due to better fit, comfort, and match to the patients’ physical characteristics. The conventional fabrication process for custom prosthetic fingers uses multiple impressions and molds combined with silicone injection molding to create the final shape. This process has not seen significant changes for decades and comes with a high cost and long wait time, stopping the prosthesis from benefitting the patient in a cost-effective, timely, and lifelike functional way. This study developed a new manufacturing approach for custom prosthetic fingers based on an additive manufactured custom thin-wall mold. The approach was based on optical 3D scanning of the amputees’ fingers and computer-aided design of custom finger prosthetic geometry and the corresponding thin-wall mold. Preliminary clinical study on an amputee patient shows the feasibility of this new custom molding approach and future work will clinically evaluate the performance of the prosthetic fingers created via the computer-aided design and additive manufacturing approach.