Persistent hyperprolactinemia following mammoplasty: a rare association

Abstract

Breast augmentation surgery is one of the most commonly performed plastic surgery procedures. Several reported cases linked onset of transient hyper prolactinemia and galactorrhea to breast implant surgery. These prior studies did not corroborate that bioactive (monomeric prolactin) was responsible for the prolactin excess. We report a patient with galactorrhea and hyperprolactinemia following breast augmentation, with several unique features. We used monomeric prolactin in the diagnosis of hyperprolactinemia and macro prolactinemia was specifically excluded. Common causes of prolactin excess such as prolactinoma, hypothyroidism and renal dysfunction were excluded. The close temporal relationship of the galactorrhea and apparent prolactin elevation shortly after augmentation mammoplasty strongly suggests a causal link. Patient continued to have galactorrhea, and prolactin level rose for two years without any apparent identified cause, except breast implantation surgery. These persistently elevated levels of prolactin contradict previously reported transient character of prolactin elevation. The submuscular location of the implant, which in theory is less likely to cause direct stimulation of the breast compared to subglandular placement, did not prevent prolactin elevation in our patient. The possibility of the breast implant resulting in neurogenic stimulation of prolactin secretion exists but remains unproven. While the definitive pathophysiologic link remains to be elucidated and could have been assisted by removal of the prostheses, the patient declined to have the implants removed. We advise all healthcare providers to be cognizant of this rare cause of prolactin excess.