A 46-year-old woman underwent left radical mastectomy with axillary lymphadenectomy in October 2005 due to a super ganglionic duct carcinoma 13 in superlymphatic quadrant isolated with positive lymph node receptors and metastasis.
In the same surgical procedure, immediate reconstruction was performed by placing an expander prosthesis (anatomical Becker) with textured silicone gel layer of 300 cc. volume, beginning the expansion 2 weeks later reaching the maximum volume.
Chemotherapy was established according to the regimen adriamycin sequencefumaamide and taxane, receiving a total of 24 sessions during the period between November 2005 and May 2007, followed by trastu.
Hormonal treatment with letrozole is maintained for approximately 3 years.
The second reconstruction time was performed in July 2006, by replacing the expander prosthesis with a textured silicone gel breast implant of 320 cc. subpectoral size in the same location.
In the follow-up clinical controls there was a depression at the level of the medial border of the mastectomy scar, in the form of a hatchet, which disliked both the patient and the surgical team itself.
The patient continued to be followed up by the Gyneco-O Service, performing control imaging tests according to the guidelines for diagnosis and treatment of malignant tumors in our hospital.
Specifically, 4 mammograms and 2 breast ultrasounds were performed between May 2006 and April 2009, with no evidence of abnormalities suggesting damage to the integrity of the prosthesis.
In March 2010, a new breast ultrasound was performed, in which a cystic ovoid image not previously reported was visualized on the anterior surface of the breast prosthesis. Therefore, the radiologist decided to practice a MRI.
This procedure was performed one month later and a nodular image was observed in the prosthesis, located in the area of internal interquarter, about 2.5cm in diameter, which showed no signs of inflammatory rupture or rupture of liquid content.
In different sections, it seemed as if an elongated, hook-shaped structure was introduced inside the prosthesis, similarly to how a finger was introduced into a balloon in a half-hynk.
The patient reported no symptoms.
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Such data on images should be explored surgically, considering the possibility of being forced to remove the breast prosthesis.
It was initially thought that perhaps the fat infiltrate could have been introduced into the prosthetic capsule and pushed the stent without breaking it, creating a deep tunnel in its interior.
During surgery, it was found that the prosthesis seemed to be intact, and that within the capsule there was no tissue that could alter the shape of the implant.
In the area of the capsule that was in contact with the site where the fat infiltrate occurred, there were no alterations, but corresponded to malignant tissue despite biopsy of the injected fatty tissue area; this fibrotic biopsy without signs in the histological study.
When removing the prosthesis to examine it, we pay attention to the fact that within it there appeared several opaque spots scattered in different places, without linear distribution, which could make us think that it was a needle.
However, at a point close to the largest of them, after performing strong compression of the prosthesis, we saw that the cohesive silicone of the implant was slightly herniated.
We decided, after removing it, to open it and send samples of the material inside it.
The implant removed was replaced with another of the same characteristics.
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The anatomopathological study informed the analyzed sample of the interior of the prosthesis as material.
