Pulmonary adverse events of breast silicone implants and silicone injection.

The incidence of breast implants and silicone injections has continuously increased since their FDA approval for use in the 1960's. The prevalence of overall adverse events is approximately 20%. The actual incidence of pulmonary adverse events is unknown. This review focuses on the pulmonary adverse events of breast implants and silicone injections. Vascular complications are represented by acute and chronic embolisation syndromes with a clinico-radiological presentation of alveolar hemorrhage. Inflammatory complications are numerous, including siliconoma, which is a granulomatous reaction mimicking a mesothelioma. On the other hand, there are some reports arguing a link between the development of auto-immune diseases and breast implants, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome, and dermatomyositis. Finally, for patients with asthma, breast implants may contribute to poor disease control. Cases of eosinophilic granulomatosis with polyangeitis have been described. Thus, it is of interest to decipherate mechanisms and incidence of these effects in prospective studies to better manage pulmonary diseases in patients wearing breast implants in order to understand their role as culprits or bystanders. In addition, characterization of subpopulations with increased risk of adverse events is needed as we highlighted that some subpopulations seem to be at greater risk of developing them, notably asthmatics.

Outcomes in chest feminization patients with a history of illicit hormone use and silicone injections.

Transfeminine patients facing barriers to gender confirming surgery sometimes pursue illicit feminization procedures such as "street" hormones and silicone injections. These procedures often yield complications and disfigurement, making surgeons and insurance companies wary of secondary breast reconstruction. This clinical series assesses illicit treatment among our transfeminine breast surgery patients and describes the presentation, surgical approaches, and outcomes of each patient. A retrospective review of transfeminine patients who underwent chest feminization surgery with a single provider between March 2018 and March 2020 identified patients with a history of illicit hormones or silicone injections. Demographics, comorbidities, preoperative diagnoses and symptoms, surgical details, and postoperative outcomes were collected. Patients were contacted for a follow-up survey concerning outcomes and satisfaction. Of the 41 transfeminine patients reviewed, eight (19.5%) had previous illicit treatment. Seven (17.1%) used non-prescribed hormones, and three (7.3%) received silicone breast injections. Two patients presented with symptoms from silicone injections; the remaining were asymptomatic. Six patients underwent subglandular breast augmentation, one had a reduction mammoplasty, and one underwent an implant exchange. Only one patient had postoperative complications that healed without surgical intervention. This series emphasizes the need to assess the prevalence of silicone injections and illicit hormone use among transgender chest feminization patients. The use of these substances was relatively high in our population compared to national averages; however, there is a low risk of postoperative complications. Providers may perform breast surgery in patients with a history of illicit augmentation practices after careful evaluation and surgical planning.

Silicone injection-induced granuloma formation, hypercalcemia and nephrolithiasis: a case report.

Hypercalcemia and nephrolithiasis have been associated with various etiologies, including dysregulation of the parathyroid glands, malignancies, or sarcoidosis. Other causes of hypercalcemia, such as granulomatous disease resulting from silicone-based cosmetic injections, have been reported but without specific emphasis on nephrolithiasis. Herein, we report an unusual case of simultaneous bilateral obstructing ureteral calculi (SBUC) triggered by recalcitrant hypercalcemia and granulomatous disease due to silicone-based cosmetic injections. A careful surgical history, physical exam, and imaging identified the underlying etiology, which was confirmed by final histopathology. Using a multidisciplinary approach, the patient's condition was successfully managed with endoscopic procedures and concurrent corticosteroid therapy.

Injected Breast Materials: Review of Imaging Features and Characteristics.

In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging-for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.

An Inhospitable World: Exploring a Model of Objectification Theory With Trans Women.

In this study, we investigated key tenets of objectification theory, a prominent model of body image disturbance, as it relates to trans women's disordered eating and intention to obtain silicone injections-a specific health risk for this population. We also incorporated appearance congruence, or the degree to which an individual personally feels that their gender expression matches their gender identity, into the objectification theory model. Results of a structural equation model using data from a sample of 173 trans women from the United States indicated that the basic objectification theory model held among this sample and that appearance congruence was associated negatively with body surveillance. However, appearance congruence did not have significant direct or indirect links (via body surveillance and body shame) with disordered eating or intention to obtain silicone injections. Thus, disordered eating and intention to obtain silicone injections are potential negative outcomes of the process of objectification among trans women, and appearance congruence does not appear to be uniquely linked to health risks associated with internalization of cultural standards of attractiveness, body surveillance, and body shame. Our findings support the application of the tenets of objectification theory with trans women as they apply to disordered eating and intention to obtain silicone injections and also indicate the need to identify other positive influences on trans women's body image to counteract internalization of cultural standards of attractiveness.

Sexual health, transition-related risk behavior and need for health care among transgender sex workers.

Background: Research has shown that sexual risk behavior, as well as transition-related risk behavior, such as uncontrolled hormone use, auto-medication, and silicone injections, may lead to several adverse health outcomes for transgender persons. Transgender sex workers are a vulnerable group within the transgender population, who are at increased risk for these health risk behaviors. However, European research into this topic and risk population remains largely absent. Aim: This study explores the prevalence of uncontrolled gender-affirming hormone use, silicone injections, and inconsistent condom use among transgender sex workers working in Antwerp, Belgium. Methods: A descriptive analysis of a survey sample of 46 transgender sex workers, supplemented with nine in-depth interviews with transgender sex workers. Results: This population of transgender sex workers has specific socio-demographic characteristics: they are all assigned male at birth, 83% identifies as female and 76% is from Latin-American descent, mainly from Ecuador. Transition-related and sexual risk behaviors are prevalent. Current uncontrolled hormone use rate is 32%, which should be seen in light of their work as well as their migration status. Inconsistent condom use with clients is reported by 33% of the sample. Of all participants, 65% has silicone injections in one or more parts of the body, and 43% of them cites health problems due to these injections. Conclusion: The specific characteristics of this largely invisible but highly vulnerable population should be taken in account when addressing this population's health risk behavior. Access to health care and social services should be ensured, and culturally tailored health interventions that take into account their social context as well as their gender identity should be developed.

Filler Migration and Granuloma Formation After Gluteal Augmentation with Free-silicone Injections.

Gluteal augmentation may be performed using a variety of techniques, including implant-based, autologous fat grafting, local flaps, impermanent filler injection, or, as in this case, by way of permanent filler injection with free-silicone. Of these, free-silicone injections carry one of the highest complication rates, specifically regarding migration of the filler material from the native injection site and induction of painful reactive soft tissue changes at the new filler location. A radiologist providing this diagnosis may assist the clinician, who often cannot obtain a history of illicit silicone injection for gluteal augmentation unless the suspicion is raised. Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection.

Breast Carcinoma Following Silicone Injection

A 57-year-old woman developed an inflammatory carcinoma in her left breast next to the spot of a silicone injection that had been used for augmentation some 20 years previously. She underwent a modified radical mastectomy with an axillary lymph node dissection. There have been relatively few cases reported in the literature that have noted breast cancer associated with silicone injections. During physical examinations, such breasts are frequently firm, tender, painful, and inflamed. Far more important, in silicone-injected breasts, carcinomas become more difficult to detect by physical examination, mam mography, and other known methods. Although no causal relationship between silicone and breast carci nomas is implied, a heightened awareness of the possible coexistence of silicone mastopathy and a breast carcinoma is necessary.

Breast Carcinoma Following Silicone Injection

A 57-year-old woman developed an inflammatory carcinoma in her left breast next to the spot of a silicone injection that had been used for augmentation some 20 years previously. She underwent a modified radical mastectomy with an axillary lymph node dissection. There have been relatively few cases reported in the literature that have noted breast cancer associated with silicone injections. During physical examinations, such breasts are frequently firm, tender, painful, and inflamed. Far more important, in silicone-injected breasts, carcinomas become more difficult to detect by physical examination, mam mography, and other known methods. Although no causal relationship between silicone and breast carci nomas is implied, a heightened awareness of the possible coexistence of silicone mastopathy and a breast carcinoma is necessary.