Recommendations for an Operative Procedure Based on a Surgical Experience Resecting Breast Cancer with Fibrous Capsule Dissemination Surrounding an Implant

Abstract

We report a case of a patient who had a bilateral silicone breast implant (SBI) placed on the anterior surface of the pectoralis major muscle and presented with extensive swelling of the left breast and induration. Invasive ductal breast carcinoma was diagnosed based on core needle biopsy results. Imaging revealed direct tumor invasion into the capsule, massive fluid accumulation around the SBI, morphological changes suggestive of compression impaction and breakage of the outermost shell of the SBI, and nodules suggestive of capsular dissemination. A total mastectomy involving both the SBI and capsule was performed. Pathological examination of the resected specimen confirmed direct tumor invasion and dissemination into the capsule. This showed that the SBI was not damaged, and that a large amount of bloody exudate had accumulated between the SBI and capsule. In cases such as this where capsular dissemination as a nodule is suspected on prior imaging, or where direct tumor invasion into the capsule and fluid accumulation between the SBI and capsule are observed, it is necessary to perform a total mastectomy in addition to complete resection of the capsule surrounding the implant without allowing the fluid within the capsule to leak, keeping in mind the capsular dissemination.