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Imaging Spectrum of Extracapsular Silicone: Correlation of US, MR Imaging, Mammographic, and Histopathologic Findings¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Sciences (C.I.C., W.A.B., U.M.H., S.S.), Department of Plastic and Reconstructive Surgery (B.W.C.), and Department of Internal Medicine (N.D.A.), Johns Hopkins University School of Medicine, Baltimore, Md; and the Department of Radiology, University of Maryland School of Medicine, Baltimore (W.A.B.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 15, 1999; revision requested April 5 and received April 26; accepted April 28. Address reprint requests to C.I.C., Department of Radiology, University of Texas, Lyndon B. Johnson General Hospital, 5656 Kelley St, Houston, TX 77026.

View larger version (158K): [in a new window]   Figure 1a.   US appearance of silicone. (a) Transverse US image of the right axilla in a woman with a 22-year history of silicone implants shows the classic appearance of extracapsular silicone: an area of increased echogenicity anteriorly (solid arrows) and diffuse "white" noise posteriorly (open arrows). (b) Transverse US image of the right axilla in a woman who underwent implant removal after rupture shows a highly echogenic area (arrows) with acoustic shadowing where the silicone blocks sound transmission, obscuring the detail of the pectoral muscle. (c) Transverse US image of the right breast in a woman with a 19-year history of silicone implants shows nearly anechoic conglomerates (arrows) surrounded by echogenic noise (n).

View larger version (88K): [in a new window]   Figure 1b.   US appearance of silicone. (a) Transverse US image of the right axilla in a woman with a 22-year history of silicone implants shows the classic appearance of extracapsular silicone: an area of increased echogenicity anteriorly (solid arrows) and diffuse "white" noise posteriorly (open arrows). (b) Transverse US image of the right axilla in a woman who underwent implant removal after rupture shows a highly echogenic area (arrows) with acoustic shadowing where the silicone blocks sound transmission, obscuring the detail of the pectoral muscle. (c) Transverse US image of the right breast in a woman with a 19-year history of silicone implants shows nearly anechoic conglomerates (arrows) surrounded by echogenic noise (n).

View larger version (140K): [in a new window]   Figure 1c.   US appearance of silicone. (a) Transverse US image of the right axilla in a woman with a 22-year history of silicone implants shows the classic appearance of extracapsular silicone: an area of increased echogenicity anteriorly (solid arrows) and diffuse "white" noise posteriorly (open arrows). (b) Transverse US image of the right axilla in a woman who underwent implant removal after rupture shows a highly echogenic area (arrows) with acoustic shadowing where the silicone blocks sound transmission, obscuring the detail of the pectoral muscle. (c) Transverse US image of the right breast in a woman with a 19-year history of silicone implants shows nearly anechoic conglomerates (arrows) surrounded by echogenic noise (n).

View larger version (62K): [in a new window]   Figure 2a.   MR imaging appearance of silicone in a woman with silicone implants. (a) Axial T1-weighted MR image (manually fine-tuned to suppress the silicone peak) of the right breast shows extracapsular silicone posteriorly (arrows), which is of low signal intensity. (b) Axial water-suppressed fast spin-echo T2-weighted MR image shows extracapsular silicone posteriorly (straight arrows), which is of high signal intensity. Note the hypointense thin lines in the interior of the implant (curved arrow), which are compatible with the collapsed elastomer shell and indicative of implant rupture.

View larger version (52K): [in a new window]   Figure 2b.   MR imaging appearance of silicone in a woman with silicone implants. (a) Axial T1-weighted MR image (manually fine-tuned to suppress the silicone peak) of the right breast shows extracapsular silicone posteriorly (arrows), which is of low signal intensity. (b) Axial water-suppressed fast spin-echo T2-weighted MR image shows extracapsular silicone posteriorly (straight arrows), which is of high signal intensity. Note the hypointense thin lines in the interior of the implant (curved arrow), which are compatible with the collapsed elastomer shell and indicative of implant rupture.

View larger version (49K): [in a new window]   Figure 3a.   Mammographic appearance of silicone. (a) Oblique mammogram of the left breast in a woman who underwent direct silicone injection more than 30 years earlier shows multiple large and small, dense globules (arrows), which are consistent with free silicone. (b) Oblique mammogram of the right breast in a woman with bilateral silicone implants shows the implant and lobular, spherical densities with fuzzy borders immediately adjacent to the implant (solid arrows) and in the axilla, which are compatible with extracapsular silicone. Note the subtle dark lines representing the implant shell (open arrows). (c) Oblique mammogram of the right breast (same patient as in b) shows two well-circumscribed, opaque masses in the axilla, which are compatible with free silicone.

View larger version (35K): [in a new window]   Figure 3b.   Mammographic appearance of silicone. (a) Oblique mammogram of the left breast in a woman who underwent direct silicone injection more than 30 years earlier shows multiple large and small, dense globules (arrows), which are consistent with free silicone. (b) Oblique mammogram of the right breast in a woman with bilateral silicone implants shows the implant and lobular, spherical densities with fuzzy borders immediately adjacent to the implant (solid arrows) and in the axilla, which are compatible with extracapsular silicone. Note the subtle dark lines representing the implant shell (open arrows). (c) Oblique mammogram of the right breast (same patient as in b) shows two well-circumscribed, opaque masses in the axilla, which are compatible with free silicone.

View larger version (38K): [in a new window]   Figure 3c.   Mammographic appearance of silicone. (a) Oblique mammogram of the left breast in a woman who underwent direct silicone injection more than 30 years earlier shows multiple large and small, dense globules (arrows), which are consistent with free silicone. (b) Oblique mammogram of the right breast in a woman with bilateral silicone implants shows the implant and lobular, spherical densities with fuzzy borders immediately adjacent to the implant (solid arrows) and in the axilla, which are compatible with extracapsular silicone. Note the subtle dark lines representing the implant shell (open arrows). (c) Oblique mammogram of the right breast (same patient as in b) shows two well-circumscribed, opaque masses in the axilla, which are compatible with free silicone.

View larger version (87K): [in a new window]   Figure 4a.   Direct silicone injection for augmentation. (a) Axial water-suppressed fast spin-echo T2-weighted MR image of the right breast shows a single large conglomerate of silicone that mimics an implant in its shape. (b) Sagittal US image at the 11-o'clock position shows a hypoechoic collection with low-level internal echoes (S). Note the area of echogenic noise at the edge of the collection (arrows).

View larger version (103K): [in a new window]   Figure 4b.   Direct silicone injection for augmentation. (a) Axial water-suppressed fast spin-echo T2-weighted MR image of the right breast shows a single large conglomerate of silicone that mimics an implant in its shape. (b) Sagittal US image at the 11-o'clock position shows a hypoechoic collection with low-level internal echoes (S). Note the area of echogenic noise at the edge of the collection (arrows).

View larger version (100K): [in a new window]   Figure 5a.   Direct silicone injection for augmentation. (a) Craniocaudal mammogram of the left breast shows well-defined (arrow) and ill-defined areas of increased opacity, which are compatible with free silicone. (b) Sagittal US image of the left breast at the 9-o'clock position shows echogenic noise obscuring the breast parenchyma in a sheetlike fashion (arrows), which represents free silicone. (c) Sagittal fat-suppressed T1-weighted MR image of the left breast shows multiple masses of low signal intensity (arrow), which are compatible with free silicone.

View larger version (132K): [in a new window]   Figure 5b.   Direct silicone injection for augmentation. (a) Craniocaudal mammogram of the left breast shows well-defined (arrow) and ill-defined areas of increased opacity, which are compatible with free silicone. (b) Sagittal US image of the left breast at the 9-o'clock position shows echogenic noise obscuring the breast parenchyma in a sheetlike fashion (arrows), which represents free silicone. (c) Sagittal fat-suppressed T1-weighted MR image of the left breast shows multiple masses of low signal intensity (arrow), which are compatible with free silicone.

View larger version (118K): [in a new window]   Figure 5c.   Direct silicone injection for augmentation. (a) Craniocaudal mammogram of the left breast shows well-defined (arrow) and ill-defined areas of increased opacity, which are compatible with free silicone. (b) Sagittal US image of the left breast at the 9-o'clock position shows echogenic noise obscuring the breast parenchyma in a sheetlike fashion (arrows), which represents free silicone. (c) Sagittal fat-suppressed T1-weighted MR image of the left breast shows multiple masses of low signal intensity (arrow), which are compatible with free silicone.

View larger version (110K): [in a new window]   Figure 6.   Photograph of an early Cronin implant. The prosthesis is shown front down for demonstration purposes. In addition to a thick silicone elastomer shell and a silicone gel of low viscosity, these implants contained a fixative Dacron patch on their dorsal aspect (arrows). During implantation, this side was placed against the chest wall.

View larger version (61K): [in a new window]   Figure 7a.   Inflammatory response to an early Cronin implant in a woman who underwent implant removal after rupture. (a) Oblique mammogram of the right breast shows architectural distortion with an area of increased opacity posteriorly (arrows), findings compatible with silicone or calcifications. (b) US image shows an echogenic shadowing mass (arrows) adjacent to a nearly anechoic collection (arrowheads). At surgery, an inflammatory mass consisting of residual silicone, fragments of the Dacron patch, and pus was found.

View larger version (130K): [in a new window]   Figure 7b.   Inflammatory response to an early Cronin implant in a woman who underwent implant removal after rupture. (a) Oblique mammogram of the right breast shows architectural distortion with an area of increased opacity posteriorly (arrows), findings compatible with silicone or calcifications. (b) US image shows an echogenic shadowing mass (arrows) adjacent to a nearly anechoic collection (arrowheads). At surgery, an inflammatory mass consisting of residual silicone, fragments of the Dacron patch, and pus was found.

View larger version (109K): [in a new window]   Figure 8.   Migration of silicone without rupture (gel leakage) in a woman with a 5-year history of polyurethane-covered silicone implants. Sagittal US image of the left axilla shows a focus of echogenic noise (arrows), which is consistent with free silicone.

View larger version (71K): [in a new window]   Figures 9, 10.   (9) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 9-year history of silicone implants. (a) Oblique mammogram of the left breast shows extrusion of silicone superiorly (arrows), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the left breast at the 12-o'clock position shows a hypoechoic mass (arrow) anterior to the implant (S), a finding compatible with extracapsular silicone. (10) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 15-year history of silicone implants. (a) Sagittal T2-weighted MR image of the right breast shows low-signal-intensity bands in the interior of the implant (black arrow), which are compatible with the ruptured elastomer shell. Note the extrusion of silicone beyond the elastomer shell (white arrow), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the right breast at the 6-o'clock position shows an anechoic area, which represents the silicone implant (S). The echogenic lines in the interior of the implant represent the ruptured elastomer shell (arrowhead), and the echogenic noise (N) represents extracapsular silicone. (c) Transverse US image at the 6-o'clock position shows echogenic noise (N), which represents extracapsular silicone (arrows).

View larger version (70K): [in a new window]   Figures 9, 10.   (9) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 9-year history of silicone implants. (a) Oblique mammogram of the left breast shows extrusion of silicone superiorly (arrows), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the left breast at the 12-o'clock position shows a hypoechoic mass (arrow) anterior to the implant (S), a finding compatible with extracapsular silicone. (10) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 15-year history of silicone implants. (a) Sagittal T2-weighted MR image of the right breast shows low-signal-intensity bands in the interior of the implant (black arrow), which are compatible with the ruptured elastomer shell. Note the extrusion of silicone beyond the elastomer shell (white arrow), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the right breast at the 6-o'clock position shows an anechoic area, which represents the silicone implant (S). The echogenic lines in the interior of the implant represent the ruptured elastomer shell (arrowhead), and the echogenic noise (N) represents extracapsular silicone. (c) Transverse US image at the 6-o'clock position shows echogenic noise (N), which represents extracapsular silicone (arrows).

View larger version (111K): [in a new window]   Figures 9, 10.   (9) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 9-year history of silicone implants. (a) Oblique mammogram of the left breast shows extrusion of silicone superiorly (arrows), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the left breast at the 12-o'clock position shows a hypoechoic mass (arrow) anterior to the implant (S), a finding compatible with extracapsular silicone. (10) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 15-year history of silicone implants. (a) Sagittal T2-weighted MR image of the right breast shows low-signal-intensity bands in the interior of the implant (black arrow), which are compatible with the ruptured elastomer shell. Note the extrusion of silicone beyond the elastomer shell (white arrow), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the right breast at the 6-o'clock position shows an anechoic area, which represents the silicone implant (S). The echogenic lines in the interior of the implant represent the ruptured elastomer shell (arrowhead), and the echogenic noise (N) represents extracapsular silicone. (c) Transverse US image at the 6-o'clock position shows echogenic noise (N), which represents extracapsular silicone (arrows).

View larger version (109K): [in a new window]   Figures 9, 10.   (9) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 9-year history of silicone implants. (a) Oblique mammogram of the left breast shows extrusion of silicone superiorly (arrows), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the left breast at the 12-o'clock position shows a hypoechoic mass (arrow) anterior to the implant (S), a finding compatible with extracapsular silicone. (10) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 15-year history of silicone implants. (a) Sagittal T2-weighted MR image of the right breast shows low-signal-intensity bands in the interior of the implant (black arrow), which are compatible with the ruptured elastomer shell. Note the extrusion of silicone beyond the elastomer shell (white arrow), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the right breast at the 6-o'clock position shows an anechoic area, which represents the silicone implant (S). The echogenic lines in the interior of the implant represent the ruptured elastomer shell (arrowhead), and the echogenic noise (N) represents extracapsular silicone. (c) Transverse US image at the 6-o'clock position shows echogenic noise (N), which represents extracapsular silicone (arrows).

View larger version (118K): [in a new window]   Figures 9, 10.   (9) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 9-year history of silicone implants. (a) Oblique mammogram of the left breast shows extrusion of silicone superiorly (arrows), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the left breast at the 12-o'clock position shows a hypoechoic mass (arrow) anterior to the implant (S), a finding compatible with extracapsular silicone. (10) Ruptured silicone implant with extracapsular extension of silicone in a woman with a 15-year history of silicone implants. (a) Sagittal T2-weighted MR image of the right breast shows low-signal-intensity bands in the interior of the implant (black arrow), which are compatible with the ruptured elastomer shell. Note the extrusion of silicone beyond the elastomer shell (white arrow), a finding compatible with extracapsular silicone. (b) Compound sagittal US image of the right breast at the 6-o'clock position shows an anechoic area, which represents the silicone implant (S). The echogenic lines in the interior of the implant represent the ruptured elastomer shell (arrowhead), and the echogenic noise (N) represents extracapsular silicone. (c) Transverse US image at the 6-o'clock position shows echogenic noise (N), which represents extracapsular silicone (arrows).

View larger version (60K): [in a new window]   Figure 11a.   Local migration of silicone between the pectoral muscles in a woman with a history of bilateral silicone implants. (a) Oblique mammogram of the right breast shows the implant in place with extrusion of silicone into the axilla (arrow). The ruptured implant was removed. (b) Sagittal US image of the right breast at the 11-o'clock position obtained 2 years later shows multiple hypoechoic globules (arrows) surrounded by extensive echogenic noise (n), findings compatible with residual silicone. Real-time imaging demonstrated that the residual silicone followed the course of the pectoral muscle. (c) Sagittal water-suppressed fast spin-echo T2-weighted MR image of the right breast shows multiple areas of high signal intensity within the leaves of the pectoral muscle (arrows), findings compatible with silicone.

View larger version (101K): [in a new window]   Figure 11b.   Local migration of silicone between the pectoral muscles in a woman with a history of bilateral silicone implants. (a) Oblique mammogram of the right breast shows the implant in place with extrusion of silicone into the axilla (arrow). The ruptured implant was removed. (b) Sagittal US image of the right breast at the 11-o'clock position obtained 2 years later shows multiple hypoechoic globules (arrows) surrounded by extensive echogenic noise (n), findings compatible with residual silicone. Real-time imaging demonstrated that the residual silicone followed the course of the pectoral muscle. (c) Sagittal water-suppressed fast spin-echo T2-weighted MR image of the right breast shows multiple areas of high signal intensity within the leaves of the pectoral muscle (arrows), findings compatible with silicone.

View larger version (81K): [in a new window]   Figure 11c.   Local migration of silicone between the pectoral muscles in a woman with a history of bilateral silicone implants. (a) Oblique mammogram of the right breast shows the implant in place with extrusion of silicone into the axilla (arrow). The ruptured implant was removed. (b) Sagittal US image of the right breast at the 11-o'clock position obtained 2 years later shows multiple hypoechoic globules (arrows) surrounded by extensive echogenic noise (n), findings compatible with residual silicone. Real-time imaging demonstrated that the residual silicone followed the course of the pectoral muscle. (c) Sagittal water-suppressed fast spin-echo T2-weighted MR image of the right breast shows multiple areas of high signal intensity within the leaves of the pectoral muscle (arrows), findings compatible with silicone.

View larger version (64K): [in a new window]   Figure 12a.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (90K): [in a new window]   Figure 12b.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (100K): [in a new window]   Figure 12c.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (127K): [in a new window]   Figure 12d.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (128K): [in a new window]   Figure 12e.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (160K): [in a new window]   Figure 12f.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (157K): [in a new window]   Figure 12g.   Siliconomas in a 45-year-old woman with a 12-year history of silicone implants. (a) Oblique mammogram of the right breast shows extrusion of silicone into the axilla (arrow). (b) Oblique mammogram after explantation of the ruptured implant shows two hyperdense masses in the posterior breast (arrows), compatible with residual silicone. A wire on the skin marks a scar. (c) Sagittal fat-suppressed T2-weighted MR image shows a hypointense area in the upper posterior breast (arrow), compatible with residual silicone. (d) US image of the upper outer quadrant of the right breast shows echogenic noise (arrows), compatible with residual silicone. (e) Photograph of the gross specimen shows a clear tentacle joining the cut surfaces of the fibrotic mass (arrow), compatible with residual silicone incorporated into the mass. (f) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of the siliconoma shows empty vacuoles representing free silicone surrounded by foreign-body giant cells. (g) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) of a pectoral muscle specimen shows empty vacuoles and foreign-body giant cell reaction (arrowheads), compatible with silicone intermixed with the muscle (m).

View larger version (62K): [in a new window]   Figure 13a.   Local migration of silicone to the axilla in a 45-year-old woman with a 12-year history of silicone implants (same patient as in Fig 12). (a) Oblique mammogram of the left breast obtained after removal of the ruptured implant shows dense material in the left axilla (arrows), a finding compatible with residual silicone. A wire on the skin marks a scar. (b) Transverse US image of the left axilla shows an echogenic area with acoustic shadowing (arrows), findings compatible with silicone. An image of the normal right axilla is provided for comparison.

View larger version (82K): [in a new window]   Figure 13b.   Local migration of silicone to the axilla in a 45-year-old woman with a 12-year history of silicone implants (same patient as in Fig 12). (a) Oblique mammogram of the left breast obtained after removal of the ruptured implant shows dense material in the left axilla (arrows), a finding compatible with residual silicone. A wire on the skin marks a scar. (b) Transverse US image of the left axilla shows an echogenic area with acoustic shadowing (arrows), findings compatible with silicone. An image of the normal right axilla is provided for comparison.

View larger version (71K): [in a new window]   Figure 14a.   Distant migration of extracapsular silicone in a 42-year-old woman who experienced left implant rupture 15 years earlier. (a) US image of the left breast shows echogenic noise with acoustic shadowing at 12 o'clock (arrows), findings compatible with residual silicone. (b) Transverse US image of a 10-cm-long palpable ridge in the left elbow (straight arrows) and the left forearm shows echogenic noise, a finding compatible with residual silicone that migrated to the forearm. Note the hypoechoic globule (curved arrow). For orientation, the cortex of the humerus is to the lower right, out of view. sq = subcutaneous tissues. (c) Axial water-suppressed T2-weighted MR images show abnormal high signal intensity along the medial border of the upper arm at the elbow (arrows). (d) Coronal T1-weighted MR image shows increased signal intensity along the medial humeral and ulnar border (arrows).

View larger version (108K): [in a new window]   Figure 14b.   Distant migration of extracapsular silicone in a 42-year-old woman who experienced left implant rupture 15 years earlier. (a) US image of the left breast shows echogenic noise with acoustic shadowing at 12 o'clock (arrows), findings compatible with residual silicone. (b) Transverse US image of a 10-cm-long palpable ridge in the left elbow (straight arrows) and the left forearm shows echogenic noise, a finding compatible with residual silicone that migrated to the forearm. Note the hypoechoic globule (curved arrow). For orientation, the cortex of the humerus is to the lower right, out of view. sq = subcutaneous tissues. (c) Axial water-suppressed T2-weighted MR images show abnormal high signal intensity along the medial border of the upper arm at the elbow (arrows). (d) Coronal T1-weighted MR image shows increased signal intensity along the medial humeral and ulnar border (arrows).

View larger version (64K): [in a new window]   Figure 14c.   Distant migration of extracapsular silicone in a 42-year-old woman who experienced left implant rupture 15 years earlier. (a) US image of the left breast shows echogenic noise with acoustic shadowing at 12 o'clock (arrows), findings compatible with residual silicone. (b) Transverse US image of a 10-cm-long palpable ridge in the left elbow (straight arrows) and the left forearm shows echogenic noise, a finding compatible with residual silicone that migrated to the forearm. Note the hypoechoic globule (curved arrow). For orientation, the cortex of the humerus is to the lower right, out of view. sq = subcutaneous tissues. (c) Axial water-suppressed T2-weighted MR images show abnormal high signal intensity along the medial border of the upper arm at the elbow (arrows). (d) Coronal T1-weighted MR image shows increased signal intensity along the medial humeral and ulnar border (arrows).

View larger version (142K): [in a new window]   Figure 14d.   Distant migration of extracapsular silicone in a 42-year-old woman who experienced left implant rupture 15 years earlier. (a) US image of the left breast shows echogenic noise with acoustic shadowing at 12 o'clock (arrows), findings compatible with residual silicone. (b) Transverse US image of a 10-cm-long palpable ridge in the left elbow (straight arrows) and the left forearm shows echogenic noise, a finding compatible with residual silicone that migrated to the forearm. Note the hypoechoic globule (curved arrow). For orientation, the cortex of the humerus is to the lower right, out of view. sq = subcutaneous tissues. (c) Axial water-suppressed T2-weighted MR images show abnormal high signal intensity along the medial border of the upper arm at the elbow (arrows). (d) Coronal T1-weighted MR image shows increased signal intensity along the medial humeral and ulnar border (arrows).