An 85-year-old woman presents for routine screening mammography. She has a positive family history for breast cancer. She also has a history of prior bilateral simple mastectomies due to severe fibrocystic condition with bilateral subglandular silicone implant insertion.

Implants were removed in 2005 due to intracapsular rupture. There is an abnormality seen in the axilla on the MLO (mediolateral oblique) view.

: Historical information is extremely valuable in this case as skin retraction is noted bilaterally mammographically, with the appearance of bilateral mastectomies.

The increased density of the mass with associated irregular boarders mammographically increases the probability of malignancy. Ultrasound shows a 1.9 cm nodule with dense shadowing, echotexture is suggestive of possible free silicone/silicone granuloma.

Ultrasound guided 9 gauge vacuum assisted breast biopsy was recommended.

Results: Chronic inflammation and foreign body material consistent with history of silicone breast implant

Discussion: Ref. Grubstein A., Cohen M., Steinmetz A., Cohen D., Siliconomas mimicking cancer. 

In this case it was important to be aware that the area of concern could have been caused by free silicone. The normal tissue response to silicone consists of the formation of a fibrous capsule. The extracapsular free silicone is walled off by an inflammatory response that leads to the formation of a silicone granuloma.

This diagnosis poses a challenge, as in this case, it can mimic a cancer. The classic sonographic appearance of a silicone granuloma is the “snowstorm appearance”, but can also appear like a complex cyst. The belief is the characteristics depend on the amount of free silicone, the extent of fibrous and foreign body reaction and the age of the collection. Whatever the manifestations are, some cases will need diagnostic work-up and possible intervention for diagnosis.

Image IQ: 85-year-old with Family History of Breast Cancer