Injection-Induced Breast Siliconomas: Clinical Implications, Evaluation and Treatment

319 Pages·2020·18.339 MB·English

by  Gustavo Emilio Schenone

Injection-Induced
Breast Siliconomas
Clinical Implications, Evaluation
and Treatment
Gustavo Emilio Schenone
Editor
123
Injection-Induced Breast Siliconomas
Gustavo Emilio Schenone
Editor
Injection-Induced Breast
Siliconomas
Clinical Implications, Evaluation
and Treatment
Editor
Gustavo Emilio Schenone
Plastic Surgery
University of Buenos Aires
Buenos Aires
Argentina
ISBN 978-3-030-24115-5 ISBN 978-3-030-24116-2 (eBook)
https://doi.org/10.1007/978-3-030-24116-2
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“Learning is the only thing that the mind never
exhausts, never fears, and never regrets.”
Leonardo da Vinci (1452–1519)
To my country, for having allowed me to
study in freedom.
To my father, Dr. Elbio Emilio Schenone,
surgeon, for showing me the fruits of honesty
and hard work.
To my mother, who constantly encouraged
me to study and improve myself.
To my wife, Silvina, and my children —
María Luz, Santiago and Josefina Inés —
for their unconditional support, for
motivating me, and for selflessly accepting
the countless hours when my work stole me
away from them.
Foreword
In the past, the injection of foreign materials into the breast was a common method
of breast augmentation. Numerous substances including liquid silicone, oil, paraf-
fin, polyacrylamide hydrogels, and other unidentified liquid gels have all been
injected into the breast parenchyma in an attempt to enlarge the breast. Not surpris-
ingly, numerous complications have resulted including infection, inflammation,
material migration with lymphatic and skin involvement, disfigurement and painful
breast masses. As a result, these patients often present for revisional or reconstruc-
tive surgery.
The difficulty lies in the fact that these patients present with a multitude of recon-
structive challenges associated with complicated decision making.
Currently, there are no international guidelines or even a clinical management
consensus that can be used to help treat these difficult patients. It is with this in mind
that this book by Dr. Gustavo Schenone becomes a vital resource for the clinician
charged with treating these patients.
The value of this book comes from the clinical judgment, and surgical skills of
the talented breast surgeons who have shared their experiences and approaches to
treating patients with these challenging problems. To that end, this is not a tradi-
tional technique-oriented textbook. Rather it focuses on specific problems and pro-
vides a number of different clinical solutions geared toward restoring the patients
back to health.
I recommend this book to mastologists, plastic surgeons, general surgeons, and
any physician involved in caring for these challenging patients.
Using the described principles, an organized, efficient, and successful treatment
plan for each patient can be realized.
Dr. Schenone and colleagues are to be congratulated for this significant
contribution.
Grand Rapids, MI, USA Dennis C. Hammond, MD
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Foreword (Spanish Edition 2017)
When Dr. Gustavo Schenone asked me to write a foreword for this book, I felt two
things: tremendous honor at having been asked; and a tremendous sense of respon-
sibility, given the importance of the book’s contents, and how devastating silicone-
related breast disease can be for those who must suffer from it.
Although there is currently a ban in many countries on the injection of liquid
silicones, paraffin, polyacrylamide hydrogels, and other gels or liquid materials
into breast parenchyma for the purpose of increasing breast size, tragically, there is
no shortage of patients who suffer from either immediate or delayed complications
of past injections. For some, this has led to them undergoing mutilating
treatments.
Despite condemnation of this procedure by many medical societies, cases con-
tinue to arise of silicone-injected patients presenting with late complications — like
infection, breast deformation, infiltration of tissues, and painful and/or malignant
tumors. This injected material also can migrate through lymphatic channels and
infiltrate the different breast planes.
Surgical resection has cosmetic consequences. Consequently, many patients
must further undergo different forms of reconstruction, either using synthetic mate-
rials or autologous tissue.
Injection-Induced Siliconomas: Clinical Implications, Evaluation and Treatment
is an excellent guide for doctors who are faced with this pathology. It springs from
Dr. Schenone’s more than 18 years of clinical and research experience on the sub-
ject, and is enriched by contributions from numerous similarly qualified experts in
related fields, all of whom have focused on the treatment of silicone-associated
breast disease.
This book not only gives readers an in-depth view into the subject of silicone-
related mammopathy, it also addresses the issue with logic and common sense. This
common-sense approach extends from the initial clinical diagnosis and required
imaging studies, to the different resection and reconstructive procedures that can be
used to treat it. In light of the total lack of clinical guidelines or consensus protocols
to manage these patients, this book is a vital contribution.
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xii Foreword (Spanish Edition 2017)
Having carefully read this thorough review compiled by Dr. Schenone, I am sure
it will be of great value to any and all mastologists and plastic surgeons who are
called upon to manage this pathology. I consider it an essential and exhaustive refer-
ence to guide decisions relating to diagnosis and treatment.
Maurizio Nava
President of the School of Oncological
Reconstructive Surgery
Milan, Italy
Preface
More than 19 years ago, during an athenaeum in the Division of Plastic Surgery at
the Hospital de Clínicas “José de San Martín,” Buenos Aires University, I partici-
pated in a discussion about a patient who suffered complications related to silicone
previously injected into her breasts. The discussion was prolonged; yet it culmi-
nated in no consensus, despite the tremendous experience and scientific expertise of
a large number of participants. This spurred me on to begin researching the subject
in both national and international publications. I could not understand how so many
thousands of women had undergone mammary silicone injections (e.g., approxi-
mately 20,000 breast augmentations by injection performed in Japan between 1965
and 1975; 10,000 in the United States; and 1.5 million in Latin America), yet the
scientific community had provided no adequate diagnostic or treatment algorithm
for any one of the complex forms of pathology that might result.
Since their first description, so-called siliconomas have been afforded scant atten-
tion in the medical literature. In fact, the incidence and prevalence of these lesions in
the female population remain unknown. Immediately and uninterruptedly, I devel-
oped a research project within the Plastic Surgery Division. I orchestrated collabora-
tions between several different divisions in the Hospital de Clínicas “José de San
Martín”—Buenos Aires University, among them Mastology, Oncological Surgery,
Rheumatology, Imaging, social work and Mental Health. I convened the country’s
plastic surgeons through the Argentine Society of Aesthetic and Reconstructive
Plastic Surgery (SACPER), informing all about our line of research and asking them
to either refer their affected patients or provide as many details about them that they
could. In this way, the research that we were conducting was rendered both more
robust and more generalizable. This, in turn, gave rise to numerous scientific studies
and presentations at national and international congresses. In 2008, I presented my
doctoral thesis in the Faculty of Medicine at the University of Buenos Aires. The title
was “Mastopathy by Injected Silicone: Evaluation and Treatment.” One prestigious
member of my evaluation jury, who had more than forty years of academic experi-
ence, expressed his interest in my, as-yet, unpublished work and encouraged me to
continue my research. Thus, the first seed for this book was planted.
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