A 53-year-old woman of male genotype sought care at the emergency department with complaints of right breast swelling, erythema, mastodynia, and bilateral palpable breast nodules. The patient had undergone male-to-female sex change surgery more than a decade previously and developed female-looking breasts by using hormonal therapy but was dissatisfied with the results. She had had liquid silicone of unknown purity and manufacturer injected directly into both breasts illicitly 2 months before seeking care.
The patient's vital signs were stable, and she was initially afebrile. Physical examination revealed a markedly enlarged, tender, and indurated right breast. Bilaterally there were firm, mobile palpable breast nodules with no axillary adenopathy. She had been treated by her internist as an outpatient with multiple courses of oral antibiotics with no improvement. Computed tomography of the chest had been performed 1 week earlier, and a representative image is shown in Figure 1.
A.Inflammatory carcinoma B.Cystosarcoma phyllodes tumor C.Silicone mastitis with abscess D.Extensive fat necrosis
Corresponding author: Gladys L. Giron, MD, St Luke's-Roosevelt Hospital Center, Division of Breast Surgery, 425 W 59th St, Suite 7A, New York, NY 10019 (e-mail: firstname.lastname@example.org).
Giron GL, Tartter PI. Image of the Month—Quiz Case. Arch Surg. 2004;139(3):341–342. doi:10.1001/archsurg.139.3.341
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