Surgical Management of Silicone Mastitis: Case Series and Review of the Literature

• Published in: Aesthetic plastic surgery Vol. 37; no. 4; pp. 738 - 745
• Main Authors: Echo, Anthony, Otake, Leo R., Mehrara, Babak J., Kraneburg, Ursula M., Agrawal, Nikhil, Da Lio, Andrew L., Shaw, William W., Lee, Gordon K.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-08-2013; Springer Nature B.V
• Subjects: Aged; Breast Implantation; Female; Free Tissue Flaps; Humans; Mammaplasty - adverse effects; Mastectomy; Mastitis - chemically induced; Mastitis - surgery; Medicine; Medicine & Public Health; Middle Aged; Original Article; Otorhinolaryngology; Plastic Surgery; Retrospective Studies; Silicones - adverse effects; Superior gluteal artery perforator flap; Breast reconstruction; Silicone mastitis; Liquid silicone injections; TRAM flap; SGAP flap; Transverse rectus abdominis myocutaneous flap
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-013-0170-9

Background
Free silicone injection for breast augmentation, which became widespread in the 1960s and continues illicitly to this day, has well-known adverse effects. In this retrospective chart review of 14 patients treated for silicone mastitis from 1990 to 2002, we present our experience with the surgical management of patients with silicone mastitis.
Methods
All the patients were women, ranging in age from 49 to 76 years old (mean age = 58.8). Patients presented to us a mean of 29.9 years after their free silicone breast injection. Treatment modalities were analyzed, and, specifically, methods of breast reconstruction involving autologous tissue transfers, implants, or a combination were evaluated.
Results
The majority of patients (12 of 14) required mastectomies for extensive silicone-infiltrated tissues. The remaining two patients had focal areas of disease and were successfully treated with excision and local breast parenchyma flaps. Autologous reconstruction was performed with a total of 20 flaps, including 12 free transverse rectus abdominis myocutaneous flaps, 4 free superior gluteal artery perforator (SGAP) flaps, and 4 pedicled latissimus dorsi (LD) flaps. Two patients had bilateral implant-based breast reconstruction.
Conclusion
A variety of reconstructive options are available for patients presenting with silicone mastitis. Once an appropriate breast cancer workup has been performed, the surgical goal is to excise as much of the silicone-infiltrated tissues as possible before reconstruction. To our knowledge, this is the first reported series that incorporates the use of SGAP and LD flaps as a means of autologous tissue reconstruction for silicone-infiltrated breasts.
Level of Evidence IV
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