Presentation
Screening breast ultrasound. Patient is asymptomatic and had undergone bilateral breast augmentation with silicone implants for cosmetic purposes 10 years before. A physical breast examination was normal and no lumps were noted in the axillary area.
Patient Data
Ultrasound demonstrated two hyperechoic right axillary lymph nodes, with a well-defined anterior margin and poorly defined posterior margin causing a "snowstorm appearance" or “echo-dense noise”.
Case Discussion
The findings are suggestive of intranodal silicone caused by an asymptomatic extracapsular breast implant rupture, confirmed subsequently by MRI (MRI images not available).
In silicone lymphadenopathy, the axillary lymph nodes may be painful and enlarged but are usually asymptomatic.
In women with breast implants, examination of the axilla by ultrasound is mandatory since silicone lymphadenopathy may be the only sign suggesting an intracapsular breast prosthesis rupture, which must be confirmed by a subsequent MRI.
The differential diagnosis of silicone lymphadenopathy includes breast cancer recurrence if the patient had a skin sparing mastectomy with reconstruction with a prosthesis.