Philippe Camus, M.D.

Dijon, France

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Breast implants - Augmentation mammaplasty (w/wo evidence for leakage/rupture)

Silicone implants may rupture and cause reaction in the adjacent tissue, lymph nodes, in the pleural space or in distant or remote organs and tissues. Silicone implant rupture can cause silicone pleural effusion, migration pneumonitis and/or the silicone implant incompatibility syndrome (SIIS) with dysimmunity (PMID 23576058). Breast implant-associated anaplastic large cell lymphoma cases are increasingly described

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.b

Pneumonitis (interstitial lung disease/ILD)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.n

Pulmonary alveolar proteinosis (PAP)
I.al

Silicone pneumonitis - 'Silicone lung'
I.am

Siliconoma

II - Pulmonary edema - Acute lung injury - ARDS

II.u

Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

III - Pulmonary/alveolar./airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

V - Pleural and/or pericardial involvement

V.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)
V.v

Silicone pleural effusion
V.w

Silicone pleural nodules - Pleural siliconomas

VII - Mediastinal involvement

VII.a

Lymphadenopathy (intrathoracic)
VII.e

Granulomatous mediastinal lymphadenopathy
VII.p

Path: Silicone lymphadenopathy

X - Systemic/Distant conditions, syndromes and reactions

X.e

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
X.h

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
X.j

Myopathy-Myositis-Polymyositis (see also under Xba)
X.k

Sarcoid-like granulomatosis (endo-/extrathoracic)
X.m

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)
X.q

Systemic inflammatory response
X.s

Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive
X.ad

Skin purpura, ecchymoses or necrosis

XII - Cardiovascular involvement / toxicity

XII.c

Pericardial effusion (w/wo tamponade)

XIII - Neoplastic conditions

XIII.f

Fibromatosis of the chest wall
XIII.h

Pulmonary nodular lymphoid hyperplasia
XIII.i

Breast implant-associated anaplastic large cell lymphoma

XV - Pathology

XV.m

Path: Lymphoid hyperplasia (including nodular- or a lymphocytic interstitial pneumonia pattern)
XV.bn

Path: Silicone droplets/vacuoles in lung tissue, pulmonary vasculature, or lymph nodes
XV.cq

Path: Silicone lymphadenopathy
XV.cr

Path: Silicone pleural nodules or siliconoma (See under Vw)

XVI - Imaging

XVI.k

Imaging: An area or areas of consolidation
XVI.av

Imaging: Displacement/migration of a breast implant
XVI.bh

Imaging: F18-PET scan positive lympadenopathy

XVIII - Distinctive patterns - 'Eye-catchers'

XVIII.c

Eye catcher: A displaced breast implant