Silicone Axillary Lymphadenopathy Associated With Rupture of Fourth-Generation Cohesive Silicone Breast Implants Following Breast Augmentation

Abstract Background Silicone implant rupture is a common complication of breast augmentation, with silicone axillary lymphadenopathy (SAL) a recognized sequela. Objectives To evaluate SAL associated with surgically confirmed rupture of fourth-generation cohesive silicone breast implants and correlate imaging with operative findings. Methods A retrospective review included 260 consecutive patients undergoing surgery for removal of one or more ruptured cohesive silicone implants identified by non-contrast breast/axillary MRI and ultrasound. The implant-side was the unit of analysis, with bilateral ruptures counted separately. Implant characteristics, including manufacturer, volume, rupture type, and implant age at explantation, were correlated with ipsilateral axillary findings. All patients had primary augmentation with Allergan plc (Irvine, CA) or Mentor Worldwide LLC (Irvine, CA) fourth-generation cohesive implants and available implant records. Operative findings confirmed implant type, size, rupture presence, and rupture characteristics. Results Among 260 patients, 299 ruptured implant-sides were identified, with imaging findings corroborated surgically. Intracapsular rupture accounted for 81.6% of ruptured implant-sides with 18.4% extracapsular ruptures. SAL occurred with both intracapsular and extracapsular rupture types but was more commonly seen with extracapsular rupture. Increasing implant age at explantation showed a strong independent association with SAL, while extracapsular rupture demonstrated a modest independent association. No significant differences in SAL were observed by implant manufacturers. Conclusions SAL was frequently observed in patients undergoing surgical management of ruptured smooth, fourth-generation cohesive silicone implants. Increasing implant age at explantation was independently associated with SAL, while extracapsular rupture showed a modest independent association. These findings strongly influence patient counseling and surgical evaluation of aging fourth-generation silicone implants. Further study of newer fifth-generation highly cohesive implants is warranted. Level of Evidence: 4 (Therapeutic)