Silicone Nodules in Armpit from Ruptured Implant

Question

I have silicone nodules still in my armpit. I recently had seven nodules and two lymph nodes out, and now several more now in my armpit! Who should I go to? What doctor should I go to after I have done four surgeries in my left breast? Can all the silicone be removed out of me? MRI revealed several in armpit and one in the middle left over from a ruptured silicone breast implant. Any idea as to why the surgeon didn't get it all out? My surgery in 2007 was three hours long and a drain placed in me afterwards. She wouldn't take me seriously when I said was experiencing soreness and pain in my armpit. Help!

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

Silicone nodules are removed surgically typically when they are symptomatic, are growing, or causing problems not just because they are seen on a MRI scan. It is often impossible to remove all traces of silicone because it is widely distributed and would potential cause harm to important structures as well as deformity and other problems. Weighing pros vs cons, risks and benefits are often difficult in this situation. I recommend that you have a lengthy conversation with a board certified plastic surgeon and if necessary seek a secondary consultation.

Armando Soto, MD, FACS · Answer

Hi there-
I'm sorry to hear about your problem. I'm sure you are worrying about this...
The good news is that there is no medical reason to worry that the silicone that remains in your armpit will ever cause you a health concern. Silicone is inert and won't harm you.
The more difficult detail is that when this happens (free silicone collecting in the axillae), there is no way to completely remove it. We are able to remove involved lymph nodes when they are able to be felt, and accessible, if they are causing a local problem, but otherwise, most patients like yourself (and there are many) will always retain a bit of the silicone in the tissues... Again, this should never cause you any problem.

David Shafer, MD, FACS · Answer

You really have to weigh the risks and benefits of the decision to remove the nodules/nodes, since there are risks with any surgery. Since the silicone is trapped by the lymph nodes in your armpit, then it requires removing this tissue. Removing this tissue is not without consequences. Make sure you have a long discussion with your surgeon before proceeding with any procedure. Good luck.

Raffy Karamanoukian, MD, FACS · Answer

Silicone nodules in the armpit and soft tissue of the chest can occur after migration and lymphatic progression of silicone particles. This is a reflection of the implant rupture and the viscosity of the silicone in your implant rather than the technique of your correcting reconstructive surgeon. It is very difficult to entirely remove all the silicone in some cases, while in other cases of silicone rupture it can be quite easy and straightforward. 
I would address these nodules individually as they arise as there is no single definitive surgery that will address all the silicone in your body at once.

Lavinia K. Chong, MD · Answer

Sorry to hear about your predicament.  Silicone implants have been reengineered significantly, since their development in the mid-60's.  Generally, the manufacturers have made the gel "stickier" or cohesive.  The implication for the patient is that in the event that the external shell fails, the filler doesn't travel all over the place.  However if you had a significant chest trauma, which caused your implants to leak, the gel could still have been dislodged.  The body is a remarkable system, which works to "contain" foreign particles, such as free silicone, either in "lumps" called granulomas or by moving free floating particles along to the regional lymph nodes, where they become apparent as "knots" in the armpits, groins, neck, etc. 
Many plastic surgeons have taken care of patients who have had the older generation implants which failed and may have developed these lumps.  The management is usually based on how many symptoms they cause.  In your case, the pain you are experiencing may be a necessary and sufficient reason to operate, however as the other consultants have outlined, it is important to realize that every operation has some risk.  The armpit is an interesting structure which contains many important nerves, blood vessels and lymphatics.  It would be advisable to select a surgeon who is familiar with the anatomy but you stil run the risk of numbness, damage to blood vessels and swelling of the entire arm, if the lymphatic system is damaged.  The latter condition, lymphedema is really difficult to manage and irreversible.  Ask your family physician or local medical society for a referral to a breast oncoplastic surgeon.  Good luck.

Steven Wallach, MD · Answer

This can happen when it is trapped by lymph nodes in your axilla. If it is really bothering you, you can have some of it removed, but probably not all of it. If your plastic surgeon does not feel comfortable doing it, then you can probably go to a breast surgeon( cancer surgeon) to see if he/she would do a dissection in your axilla to remove them.

Robin T.W. Yuan, MD · Answer

Generally after a rupture of silicone gel implant, one that is extracapsular as in your case, it is impossible to removal all the gel. Usually this does not cause complications and surgery to remove all of the gel can be more disfiguring and disabling than leaving the gel alone. If you can easily palpate the nodules and they are not merely an MRI finding, then ones that are symptomatic might be easily removed if they are accessible. A plastic surgeon can do this with or without the assistance of a general surgeon.

George J. Beraka, MD (retired) · Answer

Hi!
In New York, we have seen at least 2 dozen breast augmentation patients similar to you.  Here are some facts:
1)  It has been scientifically shown that silicone does not cause any diseases.  Therefore, it is not necessary to remove every last bit of silicone from your body.
2)  Even if you want it all removed, it may not be possible without creating a deformity in your breast or your axilla.
3)  Sometimes it is impossible to remove all the silicone under any circumstances, because it is embedded in the tissues.
4)  It is really unlikely that silicone in a lymph node would cause a lot of pain.
Go see a breast surgeon (not a plastic surgeon) for an evaluation.  The good news is that the new breast implants don't do this, because the gel is very cohesive and stays in place.

Richard P. Rand, MD, FACS (retired) · Answer

Sometimes it is not pssible to remove all of the extravasated gel, especially in cases like yours where the rupture was extracapsular and the gel escaped into the tissues.  Your lymph nodes keep trying to trap it and those that can be safely removed can be excised.  
Some of the nodes, however, get dangerously close to vital structures in your armpit like major nerves and blood vessles.  In this case, it is NOT safe to try to remove them. They have been shown to not cause you any health problems, so sometimes the best plan is to remove what you can safely and leave the rest.

Silicone Nodules in Armpit from Ruptured Implant

Answers (9)

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