Contralateral axillary silicone lymphadenopathy after modified
radical mastectomy and reconstruction
Received: 8 March 2014 / Accepted: 4 May 2014
Springer-Verlag Berlin Heidelberg 2014
Abstract We describe a 49-year-old female patient who was
diagnosed with breast cancer in her left breast. The patient
underwent a modified radical mastectomy and immediate
reconstruction with the placement of an expander implant.
Two years later, the patient suffered a minor trauma and began
to feel the softening of her reconstructed breast, and a growing
palpable mass appeared in the contralateral (right) axilla.
Examinations revealed the intracapsular rupture of the ex-
pander implant. Aspiration cytology from the palpable axil-
lary mass suggested silicone lymphadenopathy. We replaced
the ruptured implant, and the lymph node from the contralat-
eral axilla was removed. Silicone lymphadenomegaly in the
right axilla was verified by a postoperative histopathological
review. This case represents a rare manifestation of silicone
lymphadenopathy caused by altered lymphatic drainage due
to previous axillary lymphadenectomy.
Level of Evidence: Level V, diagnostic study.
Keywords Breast cancer
Modified radical mastectomy
Silicone implants are widely used in aesthetic and reconstruc-
tive breast surgery. Implant rupture and consequential silicone
lymphadenopathy due to the transportation of silicone parti-
cles by macrophages to regional lymph nodes are well de-
scribed [1–5]. The granulomatous reaction in the affected
lymph nodes can mimic breast cancer metastasis, causing
differential diagnostic problems [6–12].
The main lymphatic drainage of the breast is directed
toward the ipsilateral axillary lymph nodes. After axillary
surgery, the lymphatic drainage pattern of the breast can
change: by removing the primary lymphatic pathways, alter-
native lymph vessels will serve as the primary efferent routes
[13, 14]. This phenomenon can explain the various recurrent
and metastatic sites of breast cancer after previous breast or
We present a case report with contralateral axillary lymph-
adenopathy following breast implant rupture after modified
radical mastectomy and reconstruction.
In 1999, a 49-year-old Hungarian Caucasian female patient
presented to the regional surgical department with a palpable
2-cm mass in the lower outer quadrant of her left breast.
Further radiological examinations and aspiration biopsy re-
vealed the presence of multifocal invasive breast cancer. The
patient underwent mastectomy with axillary lymphadenecto-
my, and her breast was immediately reconstructed with a
submuscular 25 % silicone/75 % saline-filled Mentor Siltex
Round Becker 25 Cohesive I 354-3500 expander implant. The
postoperative pathological finding confirmed the diagnosis of
grade II invasive ductal breast cancer with an extensive
intraductal component and the involvement of a left axillary
lymph node (one out of 14 nodes).
B. Dorogi (*)
Department of Breast and Sarcoma Surgery, National Institute of
Oncology, Ráth Gy. u. 7-9., 1122 Budapest, Hungary
Department of Pathology, National Institute of Oncology, Ráth Gy. u.
7-9., 1122 Budapest, Hungary
Eur J Plast Surg (2014) 37:505–
/Published online: 1 June 2014