Contralateral Axillary Lymph Node Enlargement in a Woman with Silent Silicone Breast Implant Rupture 30 Years After Breast Cancer Diagnosis: A Lesson to Be Learnt

Helen J Trihia (1), Epthymia Souka (2), Gabriela Stanc (3), George Galanopoulos (4), Eleftheria Ignatiadou (5), Ioannis Provatas (6)
(1) Departments of Pathology, Metaxas Cancer Memorial Hospital, Piraeus, Greece , Greece,
(2) Departments of Pathology, Metaxas Cancer Memorial Hospital, Piraeus, Greece, Greece,
(3) Departments of Pathology, Metaxas Cancer Memorial Hospital, Piraeus, Greece , Greece,
(4) Departments of Pathology, Metaxas Cancer Memorial Hospital, Piraeus, Greece , Greece,
(5) Departments of Pathology, Metaxas Cancer Memorial Hospital, Piraeus, Greece, Greece,
(6) Breast Unit, Metaxas Cancer Memorial Hospital, Piraeus, Greece, Greece


Background: Silicone lymphadenopathy is a recognized complication of silicone implant rupture. It occurs when silicone droplets migrate from breast implants to lymph nodes, resulting in the formation of granulomas (known as siliconoma) and lymph node enlargement. The ipsilateral axillary lymph nodes are most commonly involved but it can also affect contralateral axillary, supraclavicular, internal mammary and mediastinal lymph nodes.
Case presentation: A 60-year-old woman with a history of left breast cancer who had undergone modified radical mastectomy (MRM) followed by left breast reconstruction with implant (30 years ago) presented with right axillary lymph nodes enlargement. An excisional biopsy of the two larger lymph nodes was performed to rule out malignancy. Pathologic examination showed features of silicone lymphadenopathy. Further examination with Ultrasound and MRI confirmed breast implant rupture.
Conclusion: Silicone lymphadenopathy following breast augmentation and reconstruction primarily affects the ipsilateral axillary nodes. Contralateral lymph node involvement is rare and may occur several years after breast cancer diagnosis and can be the first sign of breast implant rupture. Although, the need to exclude malignancy in such cases is of outmost importance, silicone lymphadenopathy should also be considered in the differential diagnosis.

Full text article

Generated from XML file


Robinson OG, Jr., Bradley EL, Wilson DS. Analysis of explanted silicone implants: a report of 300 patients. Ann Plast Surg. 1995;34(1):1-6; discussion -7.

Silverman BG, Brown SL, Bright RA, Kaczmarek RG, Arrowsmith-Lowe JB, Kessler DA. Reported complications of silicone gel breast implants: an epidemiologic review. Ann Intern Med. 1996;124(8):744-56.

McLaughlin JK, Lipworth L, Murphy DK, Walker PS. The safety of silicone gel-filled breast implants: a review of the epidemiologic evidence. Ann Plast Surg. 2007;59(5):569-80.

Marotta JS, Widenhouse CW, Habal MB, Goldberg EP. Silicone gel breast implant failure and frequency of additional surgeries: analysis of 35 studies reporting examination of more than 8000 explants. Journal of Biomedical Materials Research: An Official Journal of The Society for Biomaterials, The Japanese Society for Biomaterials, and The Australian Society for Biomaterials. 1999;48(3):354-64.

Hölmich LR, Fryzek JP, Kjøller K, Breiting VB, Jørgensen A, Krag C, et al. The diagnosis of silicone breast-implant rupture: clinical findings compared with findings at magnetic resonance imaging. Annals of plastic surgery. 2005;54(6):583-9.

Paetau AA, McLaughlin SA, McNeil RB, Sternberg E, TerKonda SP, Waldorf JC, et al. Capsular contracture and possible implant rupture: is magnetic resonance imaging useful? Plastic and reconstructive surgery. 2010; 125(3):830-5.

Gorczyca DP, Gorczyca SM, Gorczyca KL. The diagnosis of silicone breast implant rupture. Plast Reconstr Surg. 2007;120(7 Suppl 1):49S-61S.

Brown SL. Epidemiology of silicone-gel breast implants. Epidemiology. 2002;13 Suppl 3:S34-9.

Zambacos GJ, Molnar C, Mandrekas AD. Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts. Aesthetic Plast Surg. 2013;37(2):278-89.

Collado-Mesa F, Yepes M, Doshi P, Umar SA, Net J. Contralateral intramammary silicone lymphadenitis in a patient with an intact standard dual-lumen breast implant in the opposite reconstructed breast. J Radiol Case Rep. 2013;7(11):24-31.

Kaufman GJ, Sakr RA, Inguenault C, Sarfati I, Nos C, Clough KB. Silicone migration to the contralateral axillary lymph nodes and breast after highly cohesive silicone gel implant failure: a case report. Cases J. 2009;2:6420.

Rivero MA, Schwartz DS, Mies C. Silicone lymphadenopathy involving intramammary lymph nodes: a new complication of silicone mammaplasty. AJR American journal of roentgenology. 1994;162(5):1089-90.

Shipchandler TZ, Lorenz RR, McMahon J, Tubbs R. Supraclavicular lymphadenopathy due to silicone breast implants. Archives of Otolaryngology–Head & Neck Surgery. 2007; 133(8):830-2.

Truong LD, Cartwright J, Jr., Goodman MD, Woznicki D. Silicone lymphadenopathy associated with augmentation mammaplasty. Morphologic features of nine cases. Am J Surg Pathol. 1988;12(6):484-91.

Dragu A, Theegarten D, Bach AD, Polykandriotis E, Arkudas A, Kneser U, et al. Intrapulmonary and cutaneous siliconomas after silent silicone breast implant failure. The breast journal. 2009;15(5):496-9.

Paredes Vila S, Gonzalez Barcala FJ, Suarez Antelo J, Moldes Rodriguez M, Abdulkader Nallib I, Valdes Cuadrado L. Pneumonitis caused by silicone gel following breast implant rupture. Ir J Med Sci. 2010;179(1):141-5.

Pfleiderer B, Garrido L. Migration and accumulation of silicone in the liver of women with silicone gel‐filled breast implants. Magnetic resonance in medicine. 1995;33(1):8-17.

Prebtani AP, Asa SL, Ezzat S. Is granulomatous thyroiditis a complication of breast implants? Endocrine pathology. 2002;13(3):239-44.

Levine RL, Allen TC, Cartwright Jr J, Cagle PT. Silicone thorax due to a ruptured breast implant. Chest. 2005;127(5):1854-7.

Gil T, Mettanes I, Aman B, Taran A, Shoshani O, Best LA, et al. Contralateral internal mammary silicone lymphadenopathy imitates breast cancer metastasis. Ann Plast Surg. 2009;63(1):39-41.

Winer LH, Sternberg TH, Lehman R, Ashley FL. Tissue Reactions to Injected Silicone Liquids. A Report of Three Cases. Arch Dermatol. 1964;90:588-93.

Sagi L, Baum S, Lyakhovitsky A, Barzilai A, Shpiro D, Trau H, et al. Silicone breast implant rupture presenting as bilateral leg nodules. Clinical and Experimental Dermatology: Clinical dermatology. 2009;34(5):e99-e101.

Sharma A, Fidias P, Hayman LA, Loomis SL, Taber KH, Aquino SL. Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 2004;24(2):419-34.

Tanis PJ, Nieweg OE, Valdes Olmos RA, Kroon BB. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg. 2001;192(3):399-409.

Eubank WB, Mankoff DA, Vesselle HJ, Eary JF, Schubert EK, Dunnwald LK, et al. Detection of locoregional and distant recurrences in breast cancer patients by using FDG PET. Radiographics. 2002;22(1):5-17.

Wellner R, Dave J, Kim U, Menes TS. Altered lymphatic drainage after breast-conserving surgery and axillary node dissection: local recurrence with contralateral intramammary nodal metastases. Clinical breast cancer. 2007;7(6):486-8.

Middleton MS. Magnetic resonance evaluation of breast implants and soft-tissue silicone. Top Magn Reson Imaging. 1998;9(2):92-137.

Santos-Briz A, Jr., Lopez-Rios F, Santos-Briz A, De Agustin PP. Granulomatous reaction to silicone in axillary lymph nodes. A case report with cytologic findings. Acta Cytol. 1999;43(6):1163-5.

Kulber DA, Mackenzie D, Steiner JH, Glassman H, Hopp D, Hiatt JR, et al. Monitoring the axilla in patients with silicone gel implants. Ann Plast Surg. 1995;35(6):580-4.

Katzin WE, Centeno JA, Feng LJ, Kiley M, Mullick FG. Pathology of lymph nodes from patients with breast implants: a histologic and spectroscopic evaluation. Am J Surg Pathol. 2005;29(4):506-11.

PP R. Rosen’s Breast Pathology. 3 ed. Philadelphia: Lipincott Williams & Wilkins; 2009.

Samreen N, Glazebrook KN, Bhatt A, Venkatesh SK, McMenomy BP, Chandra A, et al. Imaging findings of mammary and systemic silicone deposition secondary to breast implants. The British journal of radiology. 2018;91(1089): 20180098.

Seiler SJ, Sharma PB, Hayes JC, Ganti R, Mootz AR, Eads ED, et al. Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture. Radiographics. 2017;37(2):366-82.

Hurwitz R. F-18 FDG positron emission tomographic imaging in a case of ruptured breast implant: inflammation or recurrent tumor? Clin Nucl Med. 2003;28(9):755-6.

Nowaczyk P, Budnicka A, Wichtowski M, Kurzawa P, Murawa D. Massive inflammatory reaction following the removal of a ruptured silicone implant masking the invasive breast cancer - case report and literature review. Pol Przegl Chir. 2016;88(1):41-7.

Kreitzberg SA, Sherbert D, DeSano J, 2nd. Becker Implant Intracapsular Rupture with Contralateral Axillary Silicone Lymphadenopathy in an Asymptomatic Patient: A Case Report and Literature Review. Cureus. 2020;12(4):e7638.

Dorogi B, Gulyás G, Kunos C, Udvarhelyi N, Mátrai Z. Contralateral axillary silicone lymphadenopathy after modified radical mastectomy and reconstruction. European Journal of Plastic Surgery. 2014;37(9):505-8.

Barranger E, Montravers F, Kerrou K, Marpeau O, Raileanu I, Antoine M, et al. Contralateral axillary sentinel lymph node drainage in breast cancer: a case report. J Surg Oncol. 2004;86(3):167-9.

Perre CI, Hoefnagel CA, Kroon BB, Zoetmulder FA, Rutgers EJ. Altered lymphatic drainage after lymphadenectomy or radiotherapy of the axilla in patients with breast cancer. Br J Surg. 1996;83(9):1258.

Daoud J, Meziou M, Kharrat M, Sellami D, Boudawara T, Frikha M. [Contralateral axillary lymph node metastasis of cancer of the breast]. Bull Cancer. 1998;85(8):713-5.

Huston TL, Pressman PI, Moore A, Vahdat L, Hoda SA, Kato M, et al. The presentation of contralateral axillary lymph node metastases from breast carcinoma: a clinical management dilemma. Breast J. 2007;13(2):158-64.

Kiluk JV, Prowler V, Lee MC, Khakpour N, Laronga C, Cox CE. Contralateral axillary nodal involvement from invasive breast cancer. Breast. 2014;23(3):291-4.

Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, et al. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Annals of surgical oncology. 2020;27:4488-99.

Morcos B, Jaradat I, El-Ghanem M. Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Eur J Surg Oncol. 2011;37(5):418-21.

Samkari A, Farsi A, Abushal M. A Rare Case Report of Siliconoma in Contralateral Axillary Lymph Node After Silicone Implant Rupture. International Journal of Science and Research. 2019;8(5):401-2.


Helen J Trihia (Primary Contact)
Epthymia Souka
Gabriela Stanc
George Galanopoulos
Eleftheria Ignatiadou
Ioannis Provatas
Trihia HJ, Souka E, Stanc G, Galanopoulos G, Ignatiadou E, Provatas I. Contralateral Axillary Lymph Node Enlargement in a Woman with Silent Silicone Breast Implant Rupture 30 Years After Breast Cancer Diagnosis: A Lesson to Be Learnt. Arch Breast Cancer [Internet]. 2021 Jul. 27 [cited 2024 May 28];:255-60. Available from:

Article Details

Most read articles by the same author(s)