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Special Feature
March 1, 2004

Image of the Month—Quiz Case

Author Affiliations

From St Luke's-Roosevelt Hospital, University Hospital of Columbia University College of Physicians and Surgeons, Division of Breast Surgery, Department of Surgery, New York, NY.



Arch Surg. 2004;139(3):341-342. doi:10.1001/archsurg.139.3.341

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.

What Is the Diagnosis?

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: