Complications following industrial liquid silicone injection

A homosexual man, 30 years old, was referred for hyperpigmented plaques on his buttocks and thighs. He also complained of varices, pain, pins and needles, and numbness of his legs. These symptoms were of approximately 1-year's duration. He had no family or personal history of varices or other venous abnormalities. Physical examination showed induration of buttocks and thighs with hyperpigmented, oval plaques, 10 to 15 cm in diameter (Fig. 1). He also had inguinal adenopathy. Varices and tenderness were observed on the legs. Examination of the chest showed enlarged breasts but no other abnormalities. Three years before this consultation he had been injected by a nonprofessional with industrial liquid silicone mixed with oil on the breasts and buttocks for cosmetic purposes to enlarge buttocks and breasts. Routine laboratory examinations were normal, including nonreactive HIV serology and a collagen-vascular workup (ANA, RhF, DSDNA, SSA, SSB). The remainder of the physical examination was also essentially normal and chest and abdominal films failed to show any abnormalities. Computerized tomography of the chest showed densities in the breast areas, compatible with silicone infiltration. Most of the silicone was located in the subcutaneous tissue. Magnetic resonance imaging (MRI) of the pelvis showed hypertense tissue surrounded by a dense, fibrotic area in all sections at the subcutaneous level, in both gluteal regions and at the lateral buttock and inguinal regions. This tissue involved the gluteus maximus and, probably, also the gluteus medius. There was a clear separation between healthy muscle and the involved tissue. Inguinal lymphadenopathy was observed, that probably was the cause of the varicosity and the fibrosis. There were only a few foci where the silicone material had accumulated and these were localized to the buttocks (Fig. 2).