599 Intramammary Melanoma Micrometastasis Within A Silicone Implanted Breast

Case Summary Melanoma of the abdominal wall is not uncommon, and sentinel lymph nodes are usually located in the lymphatic drainage basins of the axilla or inguinal region. Less frequently, interval sentinel lymph nodes can be found along the lymphatic vessels between the primary cancer and nearest basin. We present the case of a 53-year-old female with silicone breast implants who underwent scar excision and sentinel lymph node biopsy for a 1mm Breslow thickness superficial spreading melanoma of the abdomen. Two lymph nodes were excised; both lying in the subcutaneous fat at the lateral aspect of the right breast capsule. Lymph node histology revealed a subcapsular melanoma deposit along with silicone lymphadenopathy in the sentinel node, and silicone lymphadenopathy in the second node. Whole body positron emission tomography (PET/CT) and magnetic resonance imaging (MRI) of the brain showed no evidence of metastases or implant rupture. Subsequent MRI breast revealed likely intracapsular implant rupture. The patient was offered removal of implants and remains under follow-up. The unusual location of the sentinel node in our patient highlights the possibility that previous breast augmentation may have altered the pattern of lymphatic drainage to the axilla. In addition, to our knowledge, this is the first reported case of silicone and melanoma deposits in a single sentinel node.

Contralateral Axillary Lymph Node Enlargement in a Woman with Silent Silicone Breast Implant Rupture 30 Years After Breast Cancer Diagnosis: A Lesson to Be Learnt

Background: Silicone lymphadenopathy is a recognized complication of silicone implant rupture. It occurs when silicone droplets migrate from breast implants to lymph nodes, resulting in the formation of granulomas (known as siliconoma) and lymph node enlargement. The ipsilateral axillary lymph nodes are most commonly involved but it can also affect contralateral axillary, supraclavicular, internal mammary and mediastinal lymph nodes.Case presentation: A 60-year-old woman with a history of left breast cancer who had undergone modified radical mastectomy (MRM) followed by left breast reconstruction with implant (30 years ago) presented with right axillary lymph nodes enlargement. An excisional biopsy of the two larger lymph nodes was performed to rule out malignancy. Pathologic examination showed features of silicone lymphadenopathy. Further examination with Ultrasound and MRI confirmed breast implant rupture. Conclusion: Silicone lymphadenopathy following breast augmentation and reconstruction primarily affects the ipsilateral axillary nodes. Contralateral lymph node involvement is rare and may occur several years after breast cancer diagnosis and can be the first sign of breast implant rupture. Although, the need to exclude malignancy in such cases is of outmost importance, silicone lymphadenopathy should also be considered in the differential diagnosis.