Silicone lymphadenopathy after treatment for recurrent triple-negative breast cancer

What happened, in summary

A 56-year-old woman was first diagnosed at age 43 with a 37 mm grade 3 triple-negative cancer of the left breast and high-grade ductal carcinoma in situ. She underwent wide local excision and axillary clearance, with cancer in 2 of 14 nodes, followed by anthracycline and cyclophosphamide, docetaxel, and whole-breast radiation. BRCA1 and BRCA2 testing found no mutations.

Five years later, she developed an invasive left-breast recurrence and right-breast ductal carcinoma in situ. She underwent completion left mastectomy, right wide local excision, and further chemotherapy, followed in 2013 by right prophylactic mastectomy and immediate bilateral flap-and-implant reconstruction. In 2019, a second left recurrence in the axillary tail was excised. It remained grade 3 triple-negative disease, with Ki-67 of 60%–70%, and she received another four cycles of docetaxel and cyclophosphamide plus chest-wall radiation.

Imaging then showed enlarged right axillary and internal-mammary nodes alongside implant rupture. Because of her recurrence history, the nodes raised substantial concern for metastatic disease. Fine-needle aspiration and later core biopsy showed reactive tissue containing silicone rather than malignancy. She needed extensive psychological support for the uncertainty and fear of recurrence. Bilateral implant exchange and capsulotomy were completed in May 2020. At last follow-up, she had no evidence of recurrent cancer and continued six-monthly surveillance.