Becker Implant Intracapsular Rupture with Contralateral Axillary Silicone Lymphadenopathy in an Asymptomatic Patient: A Case Report and Literature Review

Silicone gel implants are widely used for cosmetic and reconstructive breast surgery. There has been a paradigm shift with increased utilization of implant-based breast reconstruction compared to autologous reconstruction in the United States over the past couple of decades. Implant rupture is a known complication of silicone gel implants with variable incidence and increased propensity with the age of the implant. Usually, the clinical findings suggestive of implant rupture are not obvious to the patient and surgeon. Intracapsular implant rupture, when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact, occurs in the majority of cases. While extracapsular rupture, which denotes silicone leakage extending beyond the capsule, is less common. In rare cases, silicone migrates beyond the capsule to distant sites, regional sites, and lymph nodes, leading to a variety of symptoms. Following mastectomy with lymph node dissection, the disruption of normal breast lymphatic drainage may result in aberrant drainage to internal mammary nodes and contralateral axillary lymph nodes. We present a unique case of axillary silicone lymphadenopathy due to contralateral breast intracapsular implant rupture in a patient with no previous ipsilateral breast surgery. The condition was found during a routine breast cancer screening. We also engage in a review of the relevant literature.