Axillary Siliconoma Associated with an Unnoticed Unilateral Implant Rupture

Abstract

Introduction: Siliconoma is a chronic inflammatory complication secondary to silicone gel leakage, with or without evident implant rupture. Its clinical presentation is variable and may mimic malignant processes, which hinders timely diagnosis and appropriate management.

Objective: To describe a case of axillary siliconoma in a patient with a history of breast augmentation, highlighting the clinical, surgical, and histopathological findings, as well as its diagnostic and therapeutic implications for surgical practice.

Case presentation: A 40-year-old female patient with a history of bilateral implant replacement who presented with a progressively enlarging right axillary mass, accompanied by paresthesias and intermittent pain. No clinical or imaging signs of capsular rupture were evident, and an MRI was not available. Fine-needle aspiration biopsy suggested a foreign body granuloma. Bilateral explantation, periareolar mastopexy, prosthetic replacement, and excision of the nodule were performed. Intraoperatively, intracapsular rupture of the right implant was confirmed. Histopathological examination revealed optically empty vacuoles, multinucleated giant cells, foamy histiocytes, and a lymphoplasmacytic infiltrate, consistent with siliconoma. The postoperative course was favorable, with complete clinical resolution at six months.

Conclusions: Siliconoma is an uncommon but significant complication in patients with breast implants and should be considered in the presence of any axillary mass, even in the absence of breast symptoms or conclusive radiological findings. The correlation between surgical history, clinical evaluation, imaging studies, and cytological and histological analyses is essential for establishing an accurate diagnosis. Timely surgical treatment prevents major complications and ensures satisfactory aesthetic and functional outcomes.