Recent explant and lymph node removal due to rupture. Concerned about silicone travelling to lymph nodes.

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.   

Thank you for your question.  Migration of silicone to all the nodes you described is unlikely.  As you suggested, you have become fixated on this issue.  Concentrate on your recovery. Best wishes.

Silicone does migrate into the axilla and up into the neck and even to the submental lymph nodes.  Usually we only remove the silicone laden enlarged lower axillary lymph nodes with the explantation.  Sometimes, additional lymph nodes fill up with silicone if the rupture is widespread and longstanding.  Silicone in lymph nodes can become infected and contribute the frozen shoulder on that side.  We recommend a lymphatic drainage program along with a detoxification program for the remaining silicone in the lymphatic system.  Only rarely do I remove submental or cervical lymph nodes (usually only when very large and symptomatic in order to rule out lymphoma.  We see a great deal of improvement due to removal of these lymph nodes unlike Dr. Feng, probably because we have a silicone detoxificiation program done at the same time as the explant.  I have never seen lymphedema due to removal of these lymph nodes as they are most likely nonfunctional due to the silicone.  About once a year, we see a seroma in the axilla (or a lymph collection), but this usually resolves without surgery.  Numbness of the inner arm is very rare, unless you operate higher in the axilla and this usually resolves by about six months and is due to scarring on the sensory nerve rather than injury to the nerve.  I have had patients both from England and from Hawaii refuse lymph node removal with the explantation, only to return to Atlanta to have the lymph nodes removed due to symptoms localized to this area which resolved both locally and their systemic symptoms improved as well after axillary lymph node removal of the abnormal lymph nodes.  As the silicone contains both carcinogens and neurotoxins (according to the information provided by Dow Corning at the trials) it makes little sense to leave this material in the patient.  We do see silicone lymph node involvement with textured implants as well, and it is very important to remove these nodes due to the association with atypical lymphoma (which is most likely a chemical associated with the lost salt technique of texturing).  The researchers in this area do recommend removal of enlarged axillary lymph nodes in these patients.