PMC4996062_01
Illustration of the ruptured PIP implant. (A) A yellow implant without signs of rupture and with visible air bubbles inside indicating possible microruptures of the implant shell. (B) Ruptured PIP device with leakage of the silicone gel after manual compression
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This maneuver resulted in rupture of the left implant, whereas the right one remained intact (Figure 1).
Illustration of histopathological and immunohistochemical (IHC) findings. (A) Histopathological features of H&E stained xanthoma tissue showing foamy histiocytes with multinucleate giant cells (magnification x200). (B) Negative expression of protein S100 by IHC in xanthoma (magnification x400). (C) Illustration of several xanthoma cells with positive nuclear expression of MIB-1 indicating low proliferation (magnification x400). (D) Strong cytoplasmatic expression of CD68 in xanthoma (magnification x400)
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The histopathology of the specimen revealed xanthoma with no evidence of malignant neoplasm (Figure 2). S100 in <10% of xanthoma cells (considered as negative). Several positively stained cells with MIB-1 indicated the absence of sarcoma and low proliferation, which supported the histopathological diagnosis of benign lesion, i.e. xanthoma (Figure 2).
Ultrasonography of the breast with the ruptured PIP implant after implant removal. The remnant xanthoma tissue is visualized as 1 mm hypoechogenic mass (marked by white crosses)
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Both breasts were evaluated by ultrasonography, showing some signs of remaining xanthoma tissue but no evidence of other pathological findings postoperatively (Figure 3).
Surgical findings. (A) Remnant xanthoma tissue was identified as 2 x 2 cm yellowish neoplasm in the lower part of the left breast. (B) Surgically removed specimen of xanthoma.
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Considering the clinical findings, and to perform a secondary reconstruction with the new breast implants creating new submuscular pockets (Figure 4). Considering the findings and patient's desire to reconstruct the breast, we proceeded with the excision of the remained xanthoma tissue and the delayed secondary breast augmentation was scheduled (Figure 4).