Delayed progressive fibrotic lung disease associated with bilateral silicone breast implant rupture: A case report

Silicone breast implants, although widely used in the United States, have been associated with a broad spectrum of pulmonary complications following implant rupture or silicone migration. These complications include pathologies such as embolic phenomena, organizing pneumonia, and, less commonly, interstitial lung disease. Usually, these complications occur years after the implant rupture, reflecting the indolent and delayed nature of the disease. In this case, we present a 77-year-old woman with a history of bilateral silicone breast implants at age 35 presented to the emergency department with progressive shortness of breath. Two years prior to her current presentation, a high-resolution computed tomography (HRCT) showed early bilateral interstitial lung disease with minimal clinical symptoms and concurrently described ruptured bilateral silicone implants. A repeat CT scan during this admission showed an increase in the progression of the disease with diffuse ground-glass opacities, reticulation, architectural distortion, and traction bronchiectasis. Extensive infectious, autoimmune, and exposure evaluation were unrevealing, and silicone-induced lung disease was felt to be the most likely culprit. Pathology examination of lung biopsy showed organizing fibrin along with foamy histiocytes with lipid laden features. Additionally, lipid-like droplet suggestive of silicone was identified in vacuolized lung tissue. Despite aggressive treatment, patient developed progressive hypoxic respiratory failure and eventually transitioned to hospice care and died shortly afterward. This case shows the potentially fatal and delayed manifestations of silicone-related pulmonary disease presenting as progressive ILD following breast implant rupture. Awareness of this association is essential for early recognition and management in patients with unexplained ILD and prior silicone exposure.