Ruptured Implant and Silicone in Lymph Node

I have done extensive research on silicone lymphadenopathy over the last 20 years as a result of breast augmentation. As a result, I have published a peer-reviewed paper with scientists from the Armed Forces Institute of Pathology in Washington, D.C. as well as from Case Western Reserve University in Cleveland. Silicone in the lymph nodes can be diagnosed by ultrasound and localized by needle localization for precise removal. The polyurethane covered gel filled breast implants are associated with extensive silicone lymphadenopathy in the axilla, retropectoral, internal mammary, and sometimes neck nodes, but never in nodes below the diaphragm. The saline implants are never associated with silicone lymphadenopathy. Ruptured gel implants are only sometimes associated with silicone lymphadenopathy. 

Silicone-laden lymph nodes, if they need to be removed, should only be removed after needle localization by a radiologist experienced with the technique. I have removed many silicone laden lymph nodes after needle localization in the past, but I have stopped due to the fact that the removal makes little difference in patient's recovery from implant illness. In addition, there are always risks of lymphedema of the arm, numbness in the arm, and seroma in the axilla. I am not aware of any medical literature showing benefit of lymph node removal in implant illness. Linked is my peer-reviewed research study on silicone and lymph nodes

         Silicone breast
implants are not intended to last a lifetime and occasionally these devices
fatigue and rupture. When this happens, the silicone is usually contained
within the fibrous capsule that surrounds the implant.

 

         Although removal of
ruptured silicone breast implants is not an emergency, most surgeons agree that
ruptured implants should be removed as soon as possible. When ruptured silicone
implants are left in place for prolonged periods of time, the silicone can
actually leak into the surrounding tissue and lymph nodes. This can result in
an inflammatory process known as a silicone granuloma. Although this problem is
not life threatening, it can make subsequent reconstruction more difficult.

 

         When ruptured
implants are removed, it may be necessary to remove the breast capsule as well.
In most cases, new breast implants can be placed during this operative
procedure. 

Ruptured Silicone Implants should be removed and replaced. Typically removal of the surrounding capsule (Capsulectomy) is also performed to remove traces of silicone. The likelihood of this happening would be more likely prior to 2006 especially after trauma. After 2006 silicone implants were all more cohesive (more gel like).

 I would recommend removal of  silicone filled lymph nodes (grossly filled, not microscopic) if lymph nodes are enlarged or easily accessible be removed and tested. The likelihood that is involved in serious condition is very rare and in fact, I reported on one of the few ever reported which occurred in more than 25 years of practice.

A ruptured implant should be replaced at a convenient time for the patient. It is not an emergency and will cause no long term health problems. The silicone will be contained by the capsule that forms around all breast implants.
It is unnecessay to remove lymph nodes if silicone is suspected. Probably everyone in this country has molecular silicone in a lymph node somewhere. Injection needles are lubricated with silicone so anytime you get a medical injection or IV, some silicone is shed into the blood and ultimately filtered through the lymphatics.

The treatment depends on which silicone implant was utlized.
The more cohesive gel impants are quite firm and do not easily spread when ruptured. However, the less cohesive gell implants can diffuse throughout the breasts. This can be quite a mess to clean up. Therefore it is best for you to find and treat these as soon as possible.

I agree- if the implants are known to be ruptured, nothing good is going to come from leaving them in place. I wouldn't want you to think that dealing with the issue is an emergency, but the longer the silicone material is allowed to stay in place, the greater the chances of further silicone migration to lymph nodes or other locations.
This further migration will only make further diagnostic maneuvers necessary in order to rule out more serious problems like breast cancer- maneuvers you might avoid if further migration can be prevented by removing your implants sooner rather than later.
Fundamentally, a silicone implant is a foreign body- if you know it's broken, it's best to have it removed.

Current recommendations are to replace or remove ruptured implants. While studies have shown that there is likely no significant _systemic_ harm from leaking silicone the silicone itself can cause local inflammation which can lead to scar tissue and other local problems over time.
And as Dr. Freund and Dr. Karamanoukian have pointed out - it is important that any new lump in your breast or armpit be evaluated to rule-out breast cancer. Don't assume it is from the silicone.
I hope this helps.

Axillary (armpit) lymph nodes most commonly occur following infection of the arm or upper extremity. They can occur from infection, cancer, and less commonly, from a ruptured silicone implant in the breast.
Lymph nodes in the armpit should never be ignored and must undergo complete evaluation to rule out malignancy. It should never be assumed that the lymph nodes are a result of a ruptured silicone implant. Seek the attention of a qualified plastic surgeon or general surgeon to examine the entire breast and axilla to determine the risk of malignancy.

I am uncertain from our questions exactly what you are asking. I will try to separate the components of your questions and hopefully this will be helpful. First, should ruptured silicone implants be removed? Yes. The body forms a capsule which compartmentalizes the silicone implant, so that, even if ruptured, they are contained within this capsule. However, if they are ruptured, then they should be removed or replaced. In this situation, it is not an emergency, but can be scheduled electively -- there is no "rush" to replace them. The second part of your question asks about silicone in the lymph nodes. Do you have enlarged lymph nodes? If so, have you had a proper work-up including a physical exam, medical imaging and possibly a lymph node biopsy? If not, these are questions that you have to address with your surgeon and primary physician sooner rather than later.
David Shafer, MD
Shafer Plastic Surgery
Manhattan

You did not mention why you believe that your implant is leaking.  With the new form of breast implants produced after 2009 there is little chance of the implant gel material migrating since the gel is more cohesive than it was prior to this time.  Therefore it may be difficult to tell if it is ruptured since the implant tends to keep its original shape. The problem is non an emergency.  You would need some type of diagnostic study to determine if it was actually ruptured such as a  mammogram, MRI or ultrasound.  With the new form of implants there is little risk of migration of Silicone to the lymph nodes.