Eur J Plast Surg (1999) 22:260±263
L.A. Lantieri ´ A. Cosnes ´ J. Wechsler ´ J.P. Baruch
Localized scleroderma of the breast after silicone gel implant
Received: 16 April 1998 / Accepted: 20 August 1998
L.A. Lantieri (
) ´ J.P. Baruch
Department of Plastic and Reconstructive Surgery,
Hôpital Henri Mondor,
51 Avenue du MarØchal de Lattre de Tassigny, F-94010 CrØteil,
Tel. +33-1-4981-25-31; Fax +33-1-4981-2532
Department of Dermatology, CHU Henri Mondor, CrØteil, France
Department of Pathology, CHU Henri Mondor, CrØteil, France
Abstract A case of localized scleroderma (morphea) in a
patient with a unilateral silicone breast implant is report-
ed. The clinical lesions showed cupuliform depressed pla-
ques with scleroatrophia of the dermis on histology. Ex-
tensive fibrosis was present. Electron microscopy and
spectrophotometry showed the presence of silicone in
the lesion. It was concluded that this localized scleroder-
ma could be related to silicone leaking into the breast tis-
Key words Breast implants ´ Morphea ´ Silicone ´
Scleroderma is a rare disorder involving connective tis-
sue, when localized to the skin it is referred to as mor-
phea. This rare dermatologic disorder is characterized
clinically by multiple circumscribed fibrotic plaques, pig-
mentation change and skin atrophy combined histologi-
cally with sclerosis of dermis and subdermis. A case of
such a syndrome in a patient who received a unilateral sil-
icone implant for breast hypoplasia is reported. Silicone
implants have been involved in various connective tissue
disorders and thus an attempt was made to determine a
A 32-year-old patient had a unilateral left breast augmentation in
1977. The reason for this was mammary hypoplasia. This was due
to a neonatal abscess. A 140 cc silicone (Down Corning) implant
was placed through a periareolar approach. Five years after implan-
tation the patient developed cupuliform lesions in the upper lateral
quadrant of the left breast. These plaques were not inflammatory.
The skin was slightly shiny but without any clinical sclerosis or sur-
rounding halo. During the next few years other lesions appeared, the
last one in 1989.
The patient was hospitalized in November 1989. There were sev-
en depressed cutaneous lesions on the breast with normal skin col-
oration. Microscopic examination of a skin biopsy showed a thick-
ened and hypocellular dermis. There was extensive fibrosis of the
dermis and replacement of fat by connective tissue without inflam-
mation. These histological changes were consistent with an old le-
sion of morphea. Electron microscopic examination showed few fi-
broblasts within thickened collagen bundles. The fibroblasts con-
tained electron-dense, irregular fragments and many lipid droplets.
They contained many irregular cytoplasmic expansions. These fea-
tures were suggestive of macrophagic activity. Spectrophotometric
analysis showed a high, light-colored peak indicative of silicone.
The diagnosis of atrophic morphea is made and correlated with im-
plantation of the silicone filled prosthesis. The implant was then re-
moved and replaced with a saline-filled implant.
The patient was then seen six years later. Clinically the initial ar-
eas of skin atrophia were still present, there were no new lesions.
The saline implant was ruptured and was replaced. She had atrophy
of the shoulder which was related to an axillary nerve paralysis fol-
lowing a scapulohumeral dislocation in 1995.
Numerous case reports of women who have undergone
augmentation mammoplasty and subsequently developed
some type of connective tissue disease or rheumatoid
complaints have been published in the past twenty years.
Many of these appeared only after the recent controversy
concerning silicone gel-filled mammary prostheses was
reported in the mass media. These case reports clearly
raise the issue of a possible relationship between silicone
and these various disorders. Before discussing specific
studies, however, it is important to put some of the issues
raised in these papers into perspective.