Free Silicone-Induced Deep Inferior Epigastric Perforator Flap Failure in the Setting of Silicone Mastitis

The illicit use of injectable silicone for cosmetic purposes in the breast has persisted for over five decades without support of the Food and Drug Administration (FDA)1 and is associated with local and systemic complications.1–3 The constellation of symptoms first described by Boo-Chai in 1969 as “silicone mastitis,”4 stems from an inflammatory reaction to silicone and consists of pain, discoloration, and irregular nodularity. Though there are numerous reports regarding silicone mastitis,4–6 the exact incidence is unknown. Unless confined to a localized area of the breast, the most effective treatment is mastectomy. As silicone infiltration increases the risk of tissue ischemia and infection, autologous tissue reconstruction mitigates these risks and theoretically offers a superior option compared with breast implant–based reconstruction. Various autologous reconstructions have been described,3,5,7 and in the instances when free tissue transfer has failed, the source of thrombotic-related failure may be unknown.3,7 To the best of our knowledge, we report the first case of deep inferior epigastric perforator (DIEP) flap loss following silicone mastitis reconstruction as a result of free silicone-precipitated thrombosis.