There have been few reports of malignant tumours related to breast implants. In addition to this report, only 11 cases of implant-associated SCC have been reported since 1992. As shown in Table 3, all of these reported patients had a long history of breast silicone implantation (> 10 years), and the average time from initial breast augmentation until SCC diagnosis was 21.9 years. The median age of patients at SCC diagnosis was 56.8 years old. The tumour had an aggressive course of prognosis; 4 of the 11 patients eventually progressed or died within 1 year, 3 of the 11 patients were disease free during the follow-up period, and 4 of the 11 patients were lost to follow-up.
Table 3
Review of the literature detailing of SCC associated with breast prosthetic implants
| Study | No. of Patients | Age at Diagnosis | Past medical history | Reason for Implantation | Type of Implant | Time Until SCC Diagnosis, years | Therapeutic Treatment | Outcome |
| Paletta et al[18], 1992 | 1 | 52 | subglandular breast augmentation | Cosmetic | Silicone implant (Heyer Schulte) | 15 | Radical mastectomy | Disease free at 12-month follow-up |
| Kitchen et al[19], 1994 | 1 | 52 | bilateral breast augmentation | Cosmetic | silicone implants | 11 | Modified radical mastectomy | Not reported |
| Talmor et al[20], 1995 | 1 | 70 | bilateral breast augmentation | Cosmetic | liquid silicone | 25 | Bilateral simple mastectomy and immediate reconstruction, then a left axillary lymph node dissection and deep muscle biopsy | Not reported |
| Zomerlei et al[10], 2015 | 1 | 58 | primary bilateral augmentation mammoplasty | Cosmetic | silicone implants | 35 | total mastectomy, sentinel lymph node biopsy, and complete capsulectomy | Not reported |
| Olsen et al[21], 2017 | 2 | 56 81 | bilateral silicone breast implants a wide excision of benign breast mass followed by reconstruction | Cosmetic reconstruction | textured saline implants silicone breast implant | 18 42 | Mastectomy with postoperative chemotherapy and radiotherapy left mastectomy and sentinel lymph node biopsy with adjuvant radiation and chemotherapy | locoregional metastasis within 8 months Liver metastasis at 5-month follow-up and died of disease |
| Zhou et al[22], 2018 | 1 | 46 | breast augmentation | Cosmetic | silicone gel breast implant | 21 | bilateral prosthesis explantation and bilateral capsulectomy with adjuvant radiation | Without clinical recurrence at 4-month follow-up |
| Buchanan[9] et al, 2018 | 1 | 65 | breast augmentation | Cosmetic | foam-covered silastic implants (Hyer Schulte) | 21 | radical mastectomy and medial chest wall resection | Disease free after an 8-year follow up |
| Goldberg et al[23], 2020 | 2 | 40 60 | breast augmentation Breast reconstruction status post benign lesion excision | Cosmetic Breast reconstruction | Smooth Saline Implants Silicone implants | 11 32 | Neoadjuvant chemotherapy, Patient expired before` chest wall resection Chemoradiation | Expired from malignant pleural effusions at 3-month follow-up Lost to follow-up |
| Liu et al, (current study) | 1 | 45 | modified radical mastectomy and reconstruction | Breast reconstruction | silicone prosthesis | 10 | left chest wall mass resection, prosthesis removal and left supraclavicular lymph node biopsy | Disease free after a 24-month follow up |
Here, we present a patient with SCC that developed from an implant capsule 10 years after breast reconstruction, and she had stable condition at the 2-year follow-up after being diagnosed with SCC. Our patient presented to the clinic initially due to abnormal breast augmentation. The suspected causes included recurrent cancer and implant rupture. According to the reported literature, the chances of capsule rupture are commonly increased 10–15 years after placement because the mean lifespan of an implant is approximately 13 years[8]. Imaging studies were used to diagnose implant-associated SCC in our patient. We diagnosed this woman with implant-associated SCC by imaging and pathological examination. Further, we suggested primary SCC of the breast instead of metastasis.
Primary SCC of the breast is a rare tumour, accounting for an estimated frequency of 0.1–3.6% of all invasive breast cancers with poor clinical outcomes[9–11]. Skin or nipple cancer and metastasis sites should be excluded when SCC is diagnosed[12]. The clinical symptoms of implant-associated SCC are likely to be a primary mammary tumour, and the histological appearance is important to make the diagnosis[13, 14]. In this report, the woman had no histologic indications of primary breast cancer, as she had a mastectomy 10 years ago. The cancer was located around the squamous epithelialized implant capsules and involved the chest wall through the capsule. Moreover, there was no clinical or radiologic evidence of cutaneous or distant invasive squamous cell carcinoma.
The pathogenesis of breast prosthetic implant-associated SCC is not clear. Metaplastic squamous epithelialization of the capsular lining or entrapment of skin or adnexal elements has been acknowledged[15]. The most common histological characterization in implant capsules was collagen fibre alignment and fibrous capsule[16, 17]. A silicone implant leads to the formation of a nonadherent surface, and a textured and rough surface may stimulate immunity, therefore enhancing the risk of an inflammatory response[8]. Squamous epithelialization metaplasia may act as a protective mechanism against chronic injury from breast implant placement. In this report, the woman had no evidence of chronic infection.
In conclusion, patients with breast prosthetic implant-associated SCC suffer from acute breast pain and enlargement excluding malignancy. We should take this seriously in patients who present with unilateral breast enlargement after prosthetic implants. This report helps us to identify this rare tumour of implant-associated SCC.