B-Mode Ultrasound Patterns of Systemic Silicone Disease

Introduction

According to statistics from the International Society of Esthetic Plastic Surgery, approximately 1.8 million breast implants were performed worldwide in 2019. The probability of intra- or extracapsular rupture of implants increases with age. Following an implant rupture, silicone can be transported via the lymphatic system to distant lymph nodes and the reticuloendothelial system, including the liver and spleen, causing an inflammatory response (N. Brautbar et al. J Biomater Sci Polym Ed 1995; 7(2): 133–145). Therefore, the deposition of silicone in the reticuloendothelial system can be defined as systemic silicone disease. The free silicone in the body tissue displays a hyperechoic pattern on ultrasound known as a “snowstorm”. The physical basis for the sonographic appearance of different stages of free silicone has been explained using body tissue models. According to these simulations, silicone leakage into surrounding body tissues can cause three primary physical interactions with an ultrasound beam: distortions due to changes in the speed of sound; refraction leading to a “lens” effect; and multiple scattering, which produces the hyperechoic “snowstorm” pattern (H. Lopez et al. J Ultrasound Med 1998;17(3): 163–170). This case report describes patterns observed via ultrasound in the liver, spleen, and lymph nodes associated with a ruptured silicone breast implant.

Publication History

Received: 13 September 2021

Accepted after revision: 27 March 2022

Article published online:
15 June 2022