Abstract Introduction Silicone breast implants have been linked to a spectrum of inflammatory complications. In 2013, the FDA reported that up to 28% of women undergoing breast reconstruction experienced adverse effects. These include autoimmune syndromes, granulomas, alveolitis, silicone emboli, and siliconomas. Though once considered biologically inert, silicone is now known to provoke immunologic responses, often years after implantation. Silicone can migrate even from intact gel implants, where it is taken up by histiocytes and may act as an antigenic stimulus, leading to both cell-mediated and humoral immune reactions. Case Description A 75-year-old woman, former smoker with a history of right breast ductal carcinoma treated with mastectomy and radiation in 2007 later developed left breast adenocarcinoma, managed with lumpectomy and radiation in 2018. She underwent bilateral breast reconstruction with implants following each resection. PET-CT in 2020 revealed new focal uptake in the left upper lobe (LUL), with biopsy showing chronic inflammation but no malignancy. By 2023, PET-CT demonstrated increasing FDG uptake in bilateral upper lobes with cavitary lesions adjacent to the anterior pleura, immediately posterior to the breast implants. Sputum culture grew Aspergillus deflectus, and she received voriconazole treatment. However, PET-CT in 2025 continued to show FDG-avid lesions. Repeat bronchoscopy and biopsy revealed no malignancy or infection. Histopathology showed reactive cytologic atypia and chronic inflammation in the right upper lobe and granulomatous inflammation in the left. Infectious disease evaluation concluded that the Aspergillus isolate likely represented colonization. Discussion This case illustrates the diagnostic challenge of PET-avid cavitary lung lesions in a patient with a history of breast cancer and implants. Despite concerning imaging and positive sputum culture, repeated biopsies were benign. The findings raise suspicion for a delayed, implant-associated inflammatory response. Clinicians should consider silicone-related lung inflammation in similar presentations, especially when malignancy and infection have been ruled out. This abstract is funded by: None
Kujundzic et al. (Fri,) studied this question.