Paraffinoma of the breast

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Classification according to ICD-10
M60.2 Foreign body granuloma in soft tissue, not elsewhere classified
ICD-10 online (WHO version 2019)

A breast paraffinoma and a silicone are special forms of sclerosing lipogranuloma in the breast area . In the vast majority of cases, the female breast is affected. Both diseases have exclusively exogenous causes and, if left untreated, have an extremely poor prognosis .

The paraffinoma, as well as the silicononomic, is caused by a foreign body reaction that arises from the injection of liquefied or liquid paraffins or silicone oils into the parenchyma of the breast for the purpose of breast enlargement or breast reconstruction .

Epidemiology and etiology

A siliconomist in the left breast of a 59-year-old patient. It was caused by a tear in the patient's silicone graft that she received two years earlier for breast reconstruction after a mastectomy .
The cracked implant with cross-linked silicone caused by the silicone of the patient pictured above.

At the beginning of the 20th century, the injection of paraffins or mineral oils under the skin of the breast was a common technique for breast enlargement in Europe . Many years later, after the undesirable side effects gradually became known, this method largely disappeared in Western Europe . Low-melting paraffins, such as Vaseline , were mostly used . In some Far Eastern countries, on the other hand, this method was still more widespread into the 1970s and is still offered there by "backyard doctors" in the 21st century. Some paraffinomas are also the result of "self-treatments" such as self-injection of gear oil into both breasts.

From the 1950s, injections of linear (non-cross-linked) silicone oils - also for the purpose of breast enlargement - became popular. However, even these substances, when freely applied to the breast, can lead to a foreign body reaction in the form of a lipogranuloma, which in such cases is called a »silicononom«. This form of breast augmentation, in which linear silicone oils such as polydimethylsiloxane were used, was widespread until 1965 .

A silicone can also develop when silicone oil leaks from a breast implant that contains linear silicone oils. In the case of the cross-linked silicone oils introduced in 1993, siliconeomas caused by tears in the implant shell are a very rare complication. The same applies to the double-lumen implants, which are much safer with regard to a possible crack, in which the silicone gel is surrounded by an additional jacket with saline solution. However, there are also known cases of siliconomas in the case of cracks in implants with cross-linked silicones.

Reports of paraffinomas in male breasts are extremely rare.

pathology

→ see main article lipogranuloma and foreign body reaction

The subcutaneous injection of non-absorbable fluids into the chest - but also generally into other areas of the body - can lead to a foreign body reaction that results in the formation of a foreign body granuloma. A foreign body granuloma is a non- infectious granuloma . This is a nodal formation of new tissue , consisting of epithelial cells , mononuclear cells or giant cells that wrap around the foreign body and encapsulate it. Lipid granulomas arise as a result of a non-specific immune response of the organism.

It can take several decades from the time of the injection until a clinically relevant paraffinoma or siliconoma forms in the breast. For example, a Berliner in Milan in 1907 had her breasts enlarged by injecting paraffin. The patient was very satisfied for about ten years with the cosmetic result, firm, soft breasts without knots. After that, small painless hard knots formed that grew larger over the next several years. Almost 20 years after the injection, she complained of pain and had a lump the size of a chicken egg in her left breast and a hazelnut-sized lump in her right breast. In a study of eight patients, the average time from paraffin injection to symptoms appeared was 24 years. The time interval was 11 to 30 years.

Clinical picture

In most cases, the paraffinoma or siliconome develops in the area where the substance was originally injected. However, due to the migration properties of foreign bodies (especially silicone oil), lipogranulomas can also form in other parts of the body, such as on the forehead, abdominal wall , groin region , on the legs, the lymph nodes or in the lungs ( intrapulmonary ).

Some of the lipogranulomas tend to ulcerate .

a) Sonogram (ultrasound recording) of a patient's breast with a silicone (white triangle) and a malignant tumor induced by the silicone (black triangle). b) Microscope image of a histological specimen of the removed tumor in HE staining .
a) Section through the tumor removed from the patient, consisting of silicone, carcinoma and surrounding healthy tissue. b) Schematic representation of the areas of the siliconoma and three carcinomas.
Microscope images of histological specimens of the removed tumor with HE staining. a) Carcinoma, an invasive micropapillary carcinoma (IMPC), and b) Silikonom with a multitude of vacuoles, fat droplets (silicone oil), macrophages and foreign body giant cells .

The permanent inflammation of the surrounding tissue by the paraffinoma can develop into a malignant tumor (a cancerous tumor ) after about one to two decades . This phenomenon was described as a late consequence of paraffin injections into the breast as early as the 1920s, but has not yet been definitively proven. Statistically, the number of cases is too small for this. In the case of siliconeomas, too, it is suspected that carcinomas can develop from them in the long term.

diagnosis

Diagnosing a siliconeoma or paraffinoma of the breast is extremely difficult. In many cases, the initial diagnosis suspects a carcinoma that has a very similar appearance. The very low incidence of the disease and the comparatively higher incidence of breast cancer make the differential diagnosis more difficult. In many cases, the anamnesis is also no help in making the diagnosis, as most patients no longer see a causal connection between the injection and the disease decades after the injection of the paraffin or silicone. Of the imaging is magnetic resonance imaging (MRI) of the ultrasound and mammography superior and allows the distinction between malignant neoplasm (cancer) and sclerosing lipogranuloma. The MRI also provides important information for planning the surgical procedure and the necessary complete removal of the lipogranuloma.

A biopsy can ensure diagnostic reliability , since there are considerable histological differences between lipogranuloma and carcinoma.

therapy

A unilateral mastectomy.

The treatment of choice for the treatment of clinically relevant lipogranuloma of the breast is mastectomy , which in most cases must be performed on both sides. Some authors recommend radical mastectomy , while others favor simple mastectomy . Only the complete removal of the lipogranuloma offers the possibility of a cure. For the subsequent reconstruction of the breast, the autologous transplantation (endogenous tissue) is particularly advantageous.

Medical history

The American surgeon James Leonard Corning was the first to use paraffin oil in surgical procedures in 1891. Vincenz Czerny described the first reconstruction of a breast in 1895. He transplanted a patient's own lipoma “to compensate” after the removal of a tumor in the breast in Heidelberg. The Austrian doctor Robert Gersuny used liquefied paraffin as a prosthetic material in 1899. To do this, he mixed one part paraffin with three parts olive oil and injected the liquid in small doses in several experiments. Gersuny assumed that the olive oil would be completely absorbed by the body and that the body's own tissue would grow around the remaining paraffin particles. The mixture has been used for various cosmetic and prosthetic purposes as well as wound closures. The effect was not achieved by the paraffin itself, but by the connective tissue that formed around it. He first injected this mixture into a woman's breast around 1899. The indication for this experiment is unclear. In the following years, a large number of doctors adopted the method developed by Gersuny for a wide variety of indications. Partly with different substances or substance mixtures. In 1911, Frederick Strange Kolle wrote about Gersuny's method that it was "painless, fast, without bleeding and without scars and with the exception of certain cases - harmless." In the "certain cases" he listed 22 different complications. They ranged from poor aesthetics to reddening of the skin at the injection site and diffusion of the paraffin into other areas to hyperplasia of the connective tissue and paraffin embolism . However, according to Kolle, these “undesirable results” could be avoided by “carrying out the procedure properly”.

The first report of complications as a result of the injection of paraffin comes from the year 1908. The Berlin doctor F. Holländer first reported in 1912 on the consequences of the injection into the chest. After that, other authors published articles about the undesirable effects of this cosmetic procedure. The Germans Kach and Bettmann then described the pathological picture of the paraffinoma. However, many years passed before there was general consensus that the short-term, immediately visible success for the patient leads to extremely unpleasant, painful and cosmetically unsatisfactory results in the long term. In 1926, H. Lyons Hunt described injections of paraffin as an "inexcusable practice" for which he blamed "cosmetic surgeons and impostors". The term "parafinoma" also goes back to Lyons Hunt. As a result, this method of breast augmentation was almost completely abandoned in the western world.

In the 1950s, the newly developed silicone oils of the polydimethylsiloxane type for breast augmentation were "discovered". From Japan this method spread to Europe via the United States . It was assumed that these inert, "sand-based" materials were well tolerated. After the number of complications in Japanese women who received breast augmentation in the form of a "silicone syringe" increased in the 1960s, the Food and Drug Administration banned such injections in 1965. The number of women who received such injections is unknown. In Las Vegas alone , their number is estimated at over 10,000.

See also

further reading

Reference books

Technical article

  • E. Haneke: Risks of permanent fillers. In: Expert Review of Dermatology 4, 2009, pp. 271-283. doi : 10.1586 / edm.09.19
  • R. Iyengar et al: Breast paraffinoma. In: Breast J 14, 2008, pp. 504-505. PMID 18657137
  • G. Di Benedetto et al: Paraffin oil injection in the body: an obsolete and destructive procedure. In: Ann Plast Surg 49, 2002, pp. 391-396. PMID 12370645
  • A. Losken and MJ Jurkiewicz: History of Breast Reconstruction. In: Breast Disease 16, 2002, pp. 3-9. PMID 15687650
  • W. Beekman et al: Augmentation Mammaplasty: The Story Before the Silicone Bag Prosthesis. In: Ann Plast Surg 43, 1999, pp. 446-451. PMID 10517477
  • RW Raven: Paraffinoma of the breast. In: Clin Oncol 7, 1981, pp. 157-161. PMID 7249438
  • TT Alagaratnam and GB Ong: Paraffinomas of the breast. In: JR Coll Surg Edinb 28, 1983, pp. 260-263. PMID 6355455
  • H. Münchow: Paraffin oil damage in tissue using the example of calcified paraffinomas in the mammae. In: Radiologia Diagnostica 7, 1966, pp. 743-747. PMID 5965924
  • LF Tinckler and FE Stock: Paraffinoma of the breast. In: Aust NZJ Surg 25, 1955, pp. 142-144. PMID 13269361
  • H. Gumrich: Roentgenological representation of mammary paraffinomas. In: Medical 14, 1955, p. 500. PMID 14383078
  • KH Krohn: About paraffinomas of the mother. In: Zentralblatt für Chirurgie 45, 1930, pp. 2772-2781.

Web links

  • Big lift. In: Der Spiegel 7, 1968, from February 12, 1968, pp. 122–123.

Individual evidence

  1. ↑ a b B. Erguvan-Dogan and WT Yang: Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications. In: AJR Am J Roentgenol 186, 2006, pp. 888-894. PMID 16498126
  2. ↑ a b c G. J. Kaufman et al .: Silicone migration to the contralateral axillary lymph nodes and breast after highly cohesive silicone gel implant failure: a case report. In: Cases J 2, 2009, 6420. PMID 20181154
  3. ^ FD Weidman: The danger of liquid petrolatum in parenteral injections. In: J Am Med Assoc 80, 1923, pp. 1761-1763.
  4. ↑ C. Markopoulos et al: Paraffinomas of the breast or oleogranulomatous mastitis - a rare entity. In: The Breast 15, 2006, pp. 540-543. PMID 16545569
  5. ^ KT Wong et al.: Paraffinoma in anterior abdominal wall mimicking liposarcoma. In: Br J Radiol 76, 2003, pp. 264-267. PMID 12711647
  6. ↑ GF D'Costa et al .: Self inflicted, bilateral oleogranuloma of the breast: Report of a bizarre case. In: Indian Journal of Pathology and Microbiology 50, 2007, pp. 373-375. PMID 17883079
  7. ↑ WS Symmers: Silicone mastitis in 'topless' waitresses and some other varieties of foreign-body mastitis. In: BMJ 3, 1968, pp. 19-22. PMID 5690841
  8. ↑ a b D. P. Gorczyca and RJ Brenner: The augmented breast: radiologic and clinical perspectives. Thieme-Verlag, 1997, ISBN 0-865-77612-1 , p. 1f limited preview in the Google book search
  9. ↑ HP Frey et al.: Silicoma and rheumatic symptoms - a known and a questionable complication of silicone implants. In: Handchir Mikrochir Plast Chir 24, 1992, pp. 171-117. PMID 1516851
  10. ↑ S. Diekmann et al.: Digital full-field mammography after breast augmentation. In: Der Radiologe 42, 2002, pp. 275-279. doi : 10.1007 / s00117-002-0730-5
  11. ↑ A. Lahiri and R. Waters: Locoregional silicone spread after high cohesive gel silicone implant rupture. In: J Plast Reconstr Aesthet Surg 59, 2006, pp. 885-856. PMID 16876092
  12. ↑ P. and B. Lower Alsbjørn: Paraffinoma of the male breast. In: Acta Chir Plast 33, 1991, pp 163-165. PMID 1722603
  13. ^ R. Büttner and C. Thomas: Allgemeine Pathologie. Schattauer Verlag, 2003, ISBN 3-794-52229-X limited preview in the Google book search
  14. ↑ G. Körbler: A contribution to the knowledge of the paraffinoma of the mammary gland after cosmetic injections. In: Klinische Wochenschrift 6, 1927, pp. 652-653. doi : 10.1007 / BF01715422
  15. ↑ a b W. S. Ho et al .: Management of paraffinoma of the breast: 10 years' experience. In: Br J Plast Surg 54, 2001, pp 232-234. PMID 11254416
  16. ↑ W. Meigel et al.: Siliconom. In: Z Hautkr 64, 1989, pp. 815-816. PMID 2683442
  17. ↑ L. Sagi et al .: Silicone breast implant rupture presenting as bilateral leg nodules. In: Clinical and Experimental Dermatology , 34, 2009, pp. E99–101. PMID 19438562
  18. ↑ B. Gebauer et al .: silicone granulomas in intrathoracic lymph nodes after rupture of a silicone double-chamber prosthesis. In: Fortschr Röntgenstr 176, 2004, pp. 1331-1332. PMID 15346272
  19. ↑ A. Dragu include: Intrapulmonary and cutaneous silicone omas after silent silicone breast implant failure. In: Breast J 15, 2009, pp. 496-499. PMID 19624416
  20. ↑ A. Rintala: ulcerating paraffinoma. In: Ann Chir Gynaecol 65, 1976, pp. 356-360. PMID 795359
  21. ↑ a b c d Y. Tanaka et al .: Invasive micropapillary carcinomas arising 42 years after augmentation mammoplasty: A case report and literature review. In: World Journal of Surgical Oncology 6, 2008, 33. doi : 10.1186 / 1477-7819-6-33 PMID 18341700
  22. ^ G. Schmorl: Paraffin granulomas. Society for Nature and Medicine Dresden. Reported in Münchner Medizinische Wochenschrift, 215, 1922.
  23. ↑ E. Rose: Dangerous long-term effects of paraffin injections. In: Bruns' contributions to clinical surgery 123, 1925, pp. 244-263.
  24. ^ HJ Kang et al.: Breast Paraffinoma Coexisting Breast Cancer. In: J Breast Cancer 9, 2006, pp. 65-68. (Full text in Korean, abstract in English)
  25. ^ GA Timberlake and GR Looney: Adenocarcinoma of the breast associated with silicone injections. In: Journal of Surgical Oncology 32, 1986, pp. 79-81. PMID 3014228
  26. ^ CM Lewis: Inflammatory carcinoma of the breast following silicone injections. In: Plast Reconstr Surg 66, 1980, pp. 134-136. PMID 7190311
  27. ^ L. Morgenstern et al.: Relation of free silicone to human breast carcinoma. In: Arch Surg 120, 1985, pp. 573-577. PMID 2985027
  28. ^ GA Timberlake and GR Looney: Adenocarcinoma of the breast associated with silicone injections. In: J Surg Oncol 32, 1986, pp. 79-81. PMID 3014228
  29. ^ PJ van Diest, WH Beekman, JJ Hage: Pathology of silicone leakage from breast implants. In: Journal of clinical pathology. Volume 51, Number 7, July 1998, pp. 493-497, PMID 9797723 , PMC 500799 (free full text) (review).
  30. ↑ J. Wang et al. a .: Magnetic resonance imaging characteristics of paraffinomas and siliconomas after mammoplasty. In: J Formos Med Assoc 101, 2002, pp. 117-123. PMID 12099202
  31. ^ PL Khong et al. a .: MR imaging of breast paraffinomas. ( Memento of the original of July 27, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. In: AJR Am J Roentgenol 173, 1999, pp. 929-932. PMID 10511150 @1@ 2Template: Webachiv / IABot / www.ajronline.org
  32. ↑ a b T. T. Alagaratnam and WF Ng: Paraffinomas of the breast: an oriental curiosity. In: Aust NZJ Surg 66, 1996, pp. 138-140. PMID 8639128
  33. ↑ I. Czeti and PP Siko: Removal of Both breasts for paraffinoma and Subsequent replacement. In: Acta Chir Plast 30, 1988, pp. 122-124. PMID 2470222
  34. ↑ KO Wustrack and HA Zarem: Surgical management of silicone mastitis. In: Plast Reconstr Surg 63, 1979, pp. 224-229. PMID 570284
  35. ^ GC Ooi et al .: Migration and lymphatic spread of calcified paraffinomas after breast augmentation. In: Australas Radiol 40, 1996, pp 404-407. PMID 8996900
  36. ↑ C. Ko et al .: Injected liquid silicone, chronic mastitis, and undetected breast cancer. In: Ann Plast Surg 34, 1995, pp. 176-179. PMID 7741437
  37. ^ JS Chen et al .: Reconstruction with bilateral pedicled TRAM flap for paraffinoma breast. In: Plast Reconstr Surg 115, 2005, pp. 96-104. PMID 15622238
  38. ^ A b N. Jacobsen: Cleavage: technology, controversy, and the ironies of the man-made breast. Rutgers University Press, 2000, ISBN 0-813-52715-5 limited preview in Google Book Search
  39. ^ V. Czerny: Plastic replacement of the mammary gland by a lipoma. In: Zentralblatt for Chirurgie 22, 1895, pp. 544-550.
  40. ^ FS Kolle: Plastic and Cosmetic Surgery. D. Appleton and Company, New York & London, 1911.
  41. ↑ H. Morestin: Inconvénients et abus of injections de paraffins. In: Bull Soc Chir Paris 31, 1908, pp. 268-298.
  42. ^ A b J. Glicenstein: Les premiers "fillers", vaseline et paraffine. You miracle à la catastrophe. In: Annales de Chirurgie Plastique Esthétique 52, 2007, pp. 157–161. PMID 16860452
  43. ^ F. Holländer, Berliner Gesellschaft für Chirurgie, In: Münch Med Wochenschr 59, 1912, p. 2842.
  44. ↑ F. Kach: About the occasional dangers of cosmetic paraffin injections. In: Münch Med Wschr 34, 1919, pp. 965–967.
  45. ^ H. Bettmann: About sequelae of subcutaneous paraffin injections. In: Berl Klin Wschr 22, 1913, p. 1040.
  46. ^ H. Lyons Hunt: Plastic Surgery Of The Head, Face And Neck. Lea & Febiger, Philadelphia and New York, 1926, 404 pages