Breast reconstruction after complications following breast augmentation with massive filler injections.

INTRODUCTION: Breast filler injections are less commonly used due to their associated complications, such as pain and foreign body reactions. Yet, these fillers are often administered illegally, resulting in aesthetic or life-threatening complications. These are treated by removing the foreign material, and the breasts are reconstructed using silicone implants or autologous tissue/fat injection. PATIENT CONCERNS: Case 1. A 45-year-old woman with polyacrylamide gel injections in both breasts visited our clinic for breast pain and tenderness. Grade I ptosis was observed in each breast, without skin necrosis and discoloration. Case 2. A 51-year-old woman, with unknown breast filler injections, visited our clinic for painful masses. Intraoperatively, massive amounts of foreign material had severely infiltrated the nearby tissues; thus, an immediate breast reconstruction could not be performed. Three months later, severe deformities including shrinkage and irregular breast skin surfaces were observed. DIAGNOSIS: Case 1. Multiple cystic lesions, fluid collection in the retromammary spaces, and diffuse infiltration were observed on mammography, computed tomography, and ultrasonography. Case 2. Multiple cystic lesions, calcified areas, and diffuse infiltrations in the axillae and retromammary spaces were observed on mammography, computed tomography, and ultrasonography. INTERVENTIONS: Case 1. The foreign material was removed and the breasts were reconstructed using silicone implants into subpectoral pocket with acellular dermal matrices (Alloderm, Lipocell Corporation). Case 2. A delayed reconstruction was undertaken using silicone implants covered by latissimus dorsi muscle flaps, 3 months after the foreign material removal. OUTCOMES: Case 1. The foreign material was removed and there were no complications such as foreign body reaction, capsular contracture. Ptosis was corrected and both breasts were symmetric with proper projection. Case 2. Residual foreign material was removed and there were no complications such capsular contracture, implant malposition. CONCLUSION: Massive injections of foreign materials into the breast can cause severe infiltration and associated foreign body reactions. By a near-complete removal of the foreign materials and breast reconstruction using silicone implants, we achieved satisfactory results, without complications such as wound disruption, capsular contracture, and implant malposition.

Mastalgia as an atypical presentation of hepatocellular carcinoma: a case report.

BACKGROUND: As the incidence of hepatocellular carcinoma (HCC) diagnoses in Saudi Arabia has recently increased due to better diagnostic techniques, the incidence of diagnosed HCC metastasis has also increased. Here, we report a case of HCC metastasis to the rib with an initially atypical presentation of mastalgia caused by extrahepatic metastasis. CASE PRESENTATION: A 31-year-old woman with a prior hepatitis B viral infection presented with a mass in the left breast accompanied by mastalgia for a 6-month duration. The patient's liver enzymes were elevated, and her serum α-fetoprotein level was particularly high. Computed tomography of her chest and abdomen showed a soft-tissue mass adhering to the upper chest wall, rib deterioration, and multiple hepatic lesions. A needle biopsy was immunohistochemically analyzed for Glypican-3, Pan-CK, and CK7 and was confirmed to be metastatic HCC. CONCLUSIONS: This metastatic HCC case is unique because it initially presented as mastalgia. We should consider the possibility of metastatic disease when assessing patients with unusual presentations who have risk factors for metastatic carcinoma.

Mioepitelioma maligno recidivante de la mama, una evolución poco frecuente / Recurrent malignant myoepithelioma of the breast, an uncommon progression

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