Large Desmoid Tumor in the Setting of Prior Cosmetic Breast Augmentation

Abstract

Desmoid tumors of the breast are rare, comprising 0.2% of all breast tumors. They may be locally invasive but do not metastasize. The etiology is multifactorial including surgical trauma in the setting of prior cosmetic augmentation breast implants. We submit a case of a large desmoid tumor in the breast following silicone implant placement three years prior to patient presentation. The patient was treated with wide local excision to negative margins and implant exchange. A follow up breast magnetic resonance imaging at 3 and 6 months did not detect a recurrence thus far.

Keywords: aggressive; Breast implant; breast mass; desmoid; fibromatosis.

Figure 1

Right breast ultrasound showed a silicone retropectoral implant. There is a heterogeneous, hypoechoic mass, measuring 5.5x3.0x6.0 cm, centered at the 3 o’clock position and 7cm from the nipple. Color Doppler image shows increased vascularity within the mass

Figure 2-4

Contrast-enhanced axial and sagittal bilateral breast MRI showed a silicone retropectoral implant in the right breast and a well-circumscribed enhancing mass centered at the 3 o’clock position and 7 cm from the nipple, measuring 3.5x5.5x8.5 cm. The mass is within the fibrous capsule of the implant. The silicone implant is displaced anteriorly by the mass. The mass demonstrates persistent kinetics MRI: magnetic resonance imaging

Figure 5

Intraoperative view of desmoid tumor adjacent to implant, through an inframammary incision

Figure 6

Desmoid tumor adherent to the fibrous capsule adjacent to the implant

Figure 7

This is the specimen mammogram depicting the mass with the biopsy clip

Figure 8

Desmoid tumor following removal, measuring 9.1x6.5x3.9 cm

Figure 9

On initial presentation the patient has fullness on the right superior/medial aspect of the breast near the chest junction

Figure 10

At two months post-operatively, the right superior medial breast near the chest wall junction appears softer