Insidious diagnosis of breast cancer in patient with previous macrolaneTM breast infiltration: A case-report

Breast augmentation is one of the most performed aesthetic surgery. In addition to the silicone breast implants, hyaluronic acid base fillers represent a non-surgical alternative. There are different types of hyaluronic acid for this purpose, including MacrolaneTM. In addition to the classic complications associated with the mammary injection of these fillers, Macrolane may cause a well-known radiological ambiguity potentially leading to a delay in the diagnosis of an underlying breast cancer. The patient underwent breast augmentation with hyaluronic acid and after several years from the procedure she noted the appearance of subcutaneous nodules and discontinuous mastodynia, attributed to previous Macrolane infiltrations: unfortunately the radiological images did not immediately show the underlying contextual cancer of the right breast. Patient underwent therapeutic right mastectomy and prophylactic left mastectomy, because of the presence of BRCA1 mutation. Simultaneously we performed an immediate reconstruction with mammary implants and biological meshes. No complications arose in the follow up. Several authors have already carried out studies on Macrolane focusing on its interference and delay in the diagnosis of malignant breast diseases. At present there is only one other case in literature reporting on a patient diagnosed with physical and instrumental examinations and delaying the diagnosis. We believe that the use of hyaluronic acid (Macrolane) fillers for breast augmentation should be avoided. In view of the complexity of these cases, a multidisciplinary approach is always advisable: we believe that a continuous dialogue between the Plastic surgeon, the Breast-dedicated Radiologist and the Oncologist is pivotal.