Management of Contralateral Breast and Axillary Nodes Silicone Migration after Implant Rupture

BACKGROUND: Silicone implants were developed in 1962 for breast augmentation and became essential in reconstruction after mastectomy. Silicone “bleeding” has been described from both ruptured and intact implants and can induce disseminated granulomatosis due to the component's high fat solubility. If not adequately treated, they can lead to disastrous cosmetic and functional consequences. Because they may mimic malignancy, prompt and reliable diagnosis should be made as early as possible. METHODS: We present a clinical case description of multiple intraparenchymal and ipsi/contralateral intraganglionic siliconomas in a woman who had undergone breast reconstruction, and a literature review of the pathophysiology of siliconomas and their diagnosis and management. RESULTS: Silicone migration to the contralateral breast and lymph node is rare and has seldom been described. The mechanism is still debated. Excluding malignancy is a priority, and systematic management must be respected to avoid misdiagnosis or unnecessary investigations. CONCLUSIONS: A multidisciplinary approach is essential for siliconoma management. Silicone-related lymphadenopathies do not require follow-up or special treatment unless they interfere with the diagnosis of tumor recurrence. Careful observation is sufficient for asymptomatic siliconomas; however, symptomatic ones should be treated depending on skin involvement and the patient's eligibility for intervention.