A 43-year-old mixed-race woman of mixed race with a history of augmentation mammoplasty performed in June 2009: periareolar incision, transglandular dissection, subfascial pocket, placement of 290 cc anatomical textured cohesive gel implants (McGhan® Medical Corporation, Santa Barbara, California, USA). Aspirative drains were placed and removed 24 hours after surgery. The postoperative period was uneventful and the result was satisfactory.
One year after the procedure, the patient presented discomfort and oedema in the right breast which subsided with non-steroidal anti-inflammatory drugs at a dose of 120 mg per day for 7 days. The subsequent evolution was satisfactory until 2015, i.e. 5 years after these symptoms and 6 years after the intervention, when the patient again presented discomfort and oedema in the right breast, as well as the appearance of galactorrhoea. Magnetic resonance imaging (MRI) studies were performed, documenting the presence of abundant periprosthetic fluid in the affected breast.

In view of the situation, an ultrasound-guided puncture was performed, obtaining 270 cc of serous material, without detritus inside, dark yellow in colour and without characteristic odour. A sample was sent for cytological study, which reported chronic mastitis with granulomatous reaction and negative culture. However, the gradual enlargement of the breast continued in the following months, and 2 new punctures were performed without success. In the second puncture, fluid was again sent for malignancy study due to the suspicion of a possible ductal carcinoma. The patient was re-evaluated by ultrasound and MRI imaging studies, but no abnormalities were found in the breast parenchyma, so it was decided to remove the implant, with capsulectomy and revision of the breast tissue by means of a trans-operative biopsy. The surgery was performed in conjunction with an oncological surgeon, who examined the mammary gland and took samples from the different quadrants.
The trans-operative and definitive study of both the sent breast tissue and the periprosthetic capsule was negative for malignancy. However, the periprosthetic fluid evacuated during surgery was positive for neoplastic cells in the cytological study. This fluid was also studied by cell block preparation and processed by histology and immunohistochemistry. The latter obtained a positive result for LACG, immunophenotype T, positive for CD 45, CD3, CD 30 and EMA (epithelial membrane antigen), negative for CKAE1/AE3 (cytokeratin), CD 20 and ALK (anaplastic lymphocyte kinase) and a proliferation index of 80%.

The haematology department proposed a positron emission tomography (PET) scan, but the patient decided not to continue with the staging studies despite the final diagnosis of lymphoma, and to date has refused to follow any type of treatment, not even the removal of the contralateral implant. She is currently (May 2016) asymptomatic.

