About 2yrs after hypercalcemia developed and prior to the diagnosis and surgery for a parathyroid adenoma, I began to develop increasing capsular contraction in old silicone subglandular implants (then around 17-18 yrs old) and progressive rock-hardness associated with radiographic evidence of capsular calcification. This was around the same time that kidney stones developed, etc., which ultimately led to the diagnosis of hyperpara. Serum calcium is rising again and recent mammogram showed progression of calcification into an axillary lymph node On recent explantation and capsulectomy (no gross evidence of rupture), path showed benign dystrophic calcification. Is there any possible relationship between the hyperpara/hypercalcemia and the capsular and breast parenchymal/axillary nodal calcification, or is the time-course for sure just a coincidence? Thanks for any research-based or clinical insight.
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Answer from PSC Doctor:
Caroline Glicksman, MD
cglicksman responded:
You have raised a very interesting question which goes far beyond your recent diagnosis of primary hypercalcemia. For many years,the lack of good scientific evidence linked silicone gel implants to every illness from Rheumatoid arthritis to cancer. The Institute of Medicine published its landmark report in 2000 in a book called “The Safety of Silicone Breast Implants”. This book presents a well documented review of the safety of the silicone implantsand is recommended reading for women like you, who are seeking research-based clinical evidence.
Calcifications can occur around any implant, however it is more often associated with older generation silicone gel implants. Calcification is particularly associated with the implant shells in older devices especially those with patches, as well as more fibrous long duration capsular contracture. Calcification occurred in almost 100% of first generation silicone gel implants and 50% of second generation implants in place over 16 years. It is also strongly related to other factors such as implant duration and implant rupture. (IOM report 1998). Although your implants were not “grossly ruptured”, there may have been silicone gel bleed through the older generation shell as well as calcifications associated with this loose silicone in the breast parenchyma and lymph nodes. Studies have also reported that most reports of calcification are in the form of hydroxyapetite crystals, and are found on the surface of the implant as well as the capsule. The presence of bacteria is also known to be involved in the body’s development of a capsule, and the introduction of bacteria at the time of surgery or years later can produce or worsen the symptoms of capsular contracture and calcification.
Based on scientific data, the presence of calcifications within your breasts, and axillary lymph nodes is most likely related to the generation of your previous gel implant, the duration of your implant (17-18 years with a severely calcified capsule), and the explantation procedure itself.
Caroline Glicksman, MD
Medical Advisory Board PSC