Silicone Implants Ruptured, Leaked into Lymph Nodes

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.

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.

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.

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,

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.

Nanic54: I will presume that you intend to replace these leaking silicone gel implants soon.  Your PS will undoubtedly review the mammograms, as "maps" to define the location of the leakage. It is likely that you will be advised to have an anterior dome capsulectomy, in which the scar shell and malfunctioning implant is removed, en bloc.  Your surgeon will endeavor to remove all of the grossly visible silicone gel.  Microscopic droplets, which are below the resolution of the human eye are not usually removed, unless a patient complains of an enlarged, tender lymph node or a mass in the breast tissue, and/or chest wall, which has been diagnosed as a silicone granuloma.  Good luck.

The silicone from your ruptured implants will disperse microscopically throughout the breast. When removing these implants, the goal is obviously to remove as much silicone as possible. This is done by removing the implant, removing the scar (capsule) from around the implant, and washing out and removing as much silicone as possible. Unfortunately, it is impossible to remove 100% of the silicone. In most cases, the removal of the majority of silicone can be performed without removal of much breast tissue and leads to an acceptable result with little to no adverse side effects. For silicone that gets into the lymph nodes, we typically to not remove those nodes unless they are reacting to that silicone (enlarged, painful, etc.).

Regarding: "Silicone Implants Ruptured, Leaked into Lymph Nodes
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?"

Breast Implants are the single most heavily studied and scrutinized implant in the history of Medicine. They have been more closely studied than artificial joints, heart valves and pacemakers. Millions of women have breast implants and enjoy them without problems. After years of studies involving thousands of women, it was made clear that
- Breast Implants do NOT cause autoimmune diseases, cancer or birth defects
- Silicone is not associated with autoimmune disease, cancer, birth defects or a host of disorders
 

Like all man-made products (cars, roofs, buildings etc), implants will eventually fail and leak. Once the leak is discovered, Plastic surgeons remove the implants, scar tissue around it and all the silicone gel in the pocket. Another implant is placed in the pocket without any problems.

Minute amounts of silicone allegedly in lymph nodes appear to have NO consequences. All syringes are lubricated with small amounts of silicone. Insulin dependent diabetics who inject themselves gradually acquire small amounts of silicone in their circulation. No disease has been associated with that silicone accumulation either.

See an experienced Plastic surgeon to either remove your implants or to remove and replace them.

Good Luck.

Dr. Peter Aldea

I am sorry that you are having problems with your implants.  When a revision is done, the goal is to remove as much of the silcone as possible, but some still may remain at the end of the procedure.

There is really no way to recover all of the silicone that has leaked into the nodes.  There has been no real evidence that this will hurt you.

It is best not to worry about it.

 

sek