Bilateral axillary silicone lymphadenopathy associated with intracapsular and extracapsular implant rupture after augmentation mammoplasty: a case report

Rupture of silicone breast implants and subsequent silicone migration can cause silicone-induced lymphadenopathy, which clinically and radiologically mimics metastatic malignancy. A 66-year-old woman presented after abnormal breast findings were detected at a general health checkup. Routine mammography followed by breast magnetic resonance imaging revealed rupture of the bilateral subglandular implants. Both intracapsular and extracapsular rupture were present on each side. Silicone had migrated to axillary lymph nodes at levels I–III. For three decades, the rupture and lymphadenopathy had caused neither symptoms nor a palpable mass. Surgery through the previous inframammary fold scars comprised meticulous implant removal, copious saline irrigation, total capsulectomy, and concurrent level II axillary lymph node dissection as an excisional biopsy. Histopathological examination confirmed a granulomatous foreign-body response, extensive fibrosis, and significant silicone deposition in the lymph nodes. At the 6-month postoperative follow-up, the patient remained clinically stable, with no complications. Breast implants are not permanent devices, and this case illustrates the value of proactive, long-term imaging follow-up even for asymptomatic patients. Total capsulectomy combined with targeted lymphadenectomy confirmed the diagnosis, although 6 months is a short follow-up period for assessing long-term outcomes. Continued clinical and radiological surveillance is therefore needed.