Breast augmentation with free silicone injections was commonplace in the 1940s, before the advent of silicone implants in the 1960s1. Due to its many complications, free silicone has principally been phased out in modern practice, however, is still used in some parts of the world. Free silicone within a breast can originate from a ruptured breast implant or free silicone injection2.
We present a case report, followed by literature review investigating MRI imaging findings of silicone injections compared with ruptured implants with a co-existing malignancy.
We present the case of a 56-year-old woman with a distant history of bilateral breast augmentation performed overseas presenting with reported MRI findings of extensive free silicone due to extracapsular rupture, with adjacent suspicious nodule. Biopsy of the suspicious nodule confirmed breast carcinoma. Subsequent investigation revealed the patient had undergone silicone injections rather than breast implants, resulting in alteration to management of her breast cancer.
Complications of free silicone within the breast can range from local reactions to granuloma formation, silicone migration and emboli2. Silicone associated mastopathy can make detection and treatment of co-existing carcinoma challenging due to confounding clinical and radiological features with limited cases in the literature3. Free silicone injections and ruptured silicone breast implants, particularly with extracapsular extension share similar MRI features and should be reviewed with care4.
Silicone related mastopathy may originate from a ruptured implant or direct silicone injection and in certain circumstances mask adjacent malignancy. Care should be taken in the interpretation of MRI features, with close correlation of detailed clinical history.