The Role of Positron Emission Tomography Imaging in Breast Implant Illness

Background: Explantation often alleviates symptoms in women with breast implant illness. However, persistent complaints in some cases may be linked to persistent silicone-induced inflammation from residual silicone particles. Positron emission tomography (PET) imaging could potentially detect this inflammation. This case series describes the PET findings in women with ongoing symptoms after explantation. Methods: A retrospective review was performed of cases from the silicone outpatient clinic at the Amsterdam University Medical Centers, the Netherlands. All women underwent PET imaging due to persistent systemic symptoms after explantation (n = 17) or replacement (n = 1). Results: Before PET imaging, silicone deposits were demonstrated in all 18 cases using ultrasound or magnetic resonance imaging. PET imaging revealed varying fluorodeoxyglucose avidity in axillary, parasternal, mediastinal, cervical, or supraclavicular lymph nodes and extranodal sites in all patients, up to 11 years after explantation. The median implantation time was 17 years, the average number of implant sets was 2, and the median time from explantation to PET was 2 years. In cases where biopsy was performed, silicone lymphadenitis with characteristic foreign body reaction was confirmed. The PET findings suggest that silicone residues can provoke inflammation even years after explantation. However, not all women with silicone residues may exhibit fluorodeoxyglucose-positive PET scans, indicating variability in susceptibility to silicone-induced inflammation. Conclusions: PET imaging may be a useful diagnostic tool for detecting silicone-induced inflammation in patients with persistent complaints after explantation. However, given inherent limitations, further research is warranted to fully assess its potential diagnostic utility in breast implant illness.