Silicone mastitis in "topless" waitresses and some other varieties of foreign-body mastitis.

Three cases of disfiguring prosthetogenic mastitis are reported.In two of the cases repeated injections of silicone fluid were followed by extensive bilateral granulomatous mastitis. The axillary lymph nodes were enlarged in both cases: in one of them a node was examined histologically and showed a remarkable proliferation of vacuolated histiocytes in the sinuses and medulla. Both patients had worked in "topless restaurants" and had been obliged to seek artificial means to maintain the excessively large bust that was necessary in that environment.The third patient's mastitis followed implantation of polyethylene prostheses designed to be varied in bulk by injection or withdrawal of saline. A foreign-body reaction developed round the prostheses. In addition, a sinus developed in a needle track on one side; this was accompanied by a local fungal and bacterial infection (Rhizopus species and Pseudomonas pyocyanea respectively).The indications for introducing foreign materials into the breasts to augment their size have to be weighed against the potential dangers that such procedures bring. The biological effects of injected silicones, particularly their long-term effects, are very imperfectly known. Statements implying that these compounds are harmless when injected are not correct. Among the hazards are (a) local sclerosing granulomatous reactions with permanent scarring, (b) histiocytosis secondary to carriage of silicones from their site of inoculation to regional lymph nodes and possibly to other parts of the lymphoreticular system, and, perhaps, (c) carcinogenic activity.