A 54 y.o. woman comes in with chest pain after her dalmatian jumped up on her chest.

What is causing her pain? ( She has subglandular breast implants.)

Our patient had an arterial injury caused by direct trauma from her Dalmatian.  She had an underlying breast implant from many years prior and the original concern was it may have been ruptured.  She was in severe pain and although interventional was called; she was taken to the OR by general surgery for hematoma evacuation.  A pulsatile bleeder was cauterized and slow oozing was noted from the edges of the implant capsule. FloSeal was applied.  She was discharged without further incident.

Presumably, what happened in this case was an injury to the fibrous capsule which forms after a silicone implant.In the early stages of silicone implants patients were encouraged to roll over the breasts with a rolling pin to break up the capsule.   Capsular contracture can also occur and is caused by an excessive fibrotic reaction to the implant with production of collagen.  It occurs in about  10% of implants.  Risk factors for this include subglandular placement of the implant, silicone(vs saline) implants and previous radiotherapy to the breast.

capsular contraction

Another more recently recognized complication of breast implants is anaplastic large cell lymphoma. This a rare condition  which can be diagnosed  7 to 10 years after implant and is often associated with an accumulation of fluid around the implant. If a patient presents with a late seroma around an implant, a lymphoma should be a concern. One woman presented 32 years after her implant.  The mechanism of this lymphoma is not known but it is thought to be related to chronic T cell stimulation. 

A dalmatian is often seen with the Budweiser Clydesdales as in this SuperBowl ad

TRIVIA

The Dalmatian is most closely associated with Croatia; Dalmatia to be specific.  They were dogs associated with the Romani people and traveled with their caravans throughout Europe.  They became known as “horse livery dogs” and were eventually adopted in England as coach dogs.

 Headson H, Kasem A, Mokbel K. Capsular contracture after breast augmentation: an update for clinical practice  2015 Arch Plast surg. Sep;42(5):532-543.

Handel N, Cordray T, GutierrexJ, et al. A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast reconstr Surg. 2006;117:757-767.

Kricheldorff J, Fallenberg E, Solbach C, et al. Breast implant-associated lymphoma. 2018. Dtsch Arztebl Int. Sept;115(38):628-6350.

Aladily T, Medeiros L, Amin M. et al. Anaplatic large cell lymphoma associated with breast implants: a report of 13 cases. Am J Durg Pathol. 2012;36.