Silicone Implants Ruptured, Leaked into Lymph Nodes

Question

I had my silicone implants put in, in 1988 under the muscle. I discoved after a mammogram about 2 weeks ago that they are both ruptured and have leaked through the capsule. Supposedly, they have been leaking for a few years. Can the silicone be completely removed from my lymph node and my chest wall? If not, what happens to the silicone that is left behind?

Joshua Lampert, MD, FACS · Answer

I have seen silicone in a lymph node after a very old silicone gel implant ruptured - on the same side as the rupture.  Typically, the lymphatics of the breast drain into the same side axilla.  After surgery, and disruption of the normal lymphatic drainage system, the flow of lymph may detour to a number of places including the opposite axilla.  After a lymph node dissection, the chances of this happening are reasonably higher.After silicone implant rupture, the plastic surgeon should make every effort to remove the silicone from the breast capsule - implant pocket.  Usually, any large lymph node in the female axilla should be removed and biopsied.I would make sure to see your ABPS board certified plastic surgeon to further discuss.

Larry S. Nichter, MD, MS, FACS · Answer

Ruptured Silicone Implants should be removed and replaced. Typically removal of the surrounding capsule (Capsulectomy) is also performed to remove traces of silicone. En bloc simply is a Latin term for "the whole thing".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 simply following the lymph nodes with silicone if only trace amounts. A board certified plastic surgeon will review your mammogram or MRI and make a recommendation for you. Personally, I would remove  silicone filled lymph nodes (grossly filled, not microscopic or trace amounts) if lymph nodes are enlarged or easily accessible and if  removed have it 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.

Thomas Fiala, MD, FACS, FRCSC · Answer

The general thoughts on treating this would be to:

	1)  remove the old implants, and intra-capsular implant material,

	2)  do a complete capsulectomy,

	3) if there is obvious extra-capsular silicone, remove what is "reasonable",

	4)  don't do more harm than good by chasing micro-droplets of silicone

	Hope that helps - see an experienced plastic surgeon for a more thorough discussion.

	 

	All the best,

Otto Joseph Placik, MD · Answer

Generally speaking attempts at removing most of the silicone are performed but removing all the silicone is nearly impossible. if the silicone contained in the lymph nodes is relatively small, this is not a concern. If however, there is extensive spread and it is not excisable, it could end up slowly migrating through your tissues.

Armando Soto, MD, FACS · Answer

Hi there-

	Regarding your question:  I had my silicone implants put in, in 1988 under the muscle. I discoved after a mammogram about 2 weeks ago that they are both ruptured and have leaked through the capsule. Supposedly, they have been leaking for a few years. Can the silicone be completely removed from my lymph node and my chest wall? If not, what happens to the silicone that is left behind?

	Once small amounts of silicone are taken up by the lymph nodes and local tissues, there is no reasonable, safe way to completely remove it. On the other hand, there is no reason to believe that these very small amounts of silicone will cause you any harm.

	As some of my colleagues have already pointed out, the intensity and depth of the research proving silicone implants to be safe is unlike that of any other medical device.

	So- don't worry, but do have your implants managed by a well-qualified surgeon Certified by The American Board of Plastic Surgery.

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Silicone Implants Ruptured, Leaked into Lymph Nodes

Answers (16)

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