Late breast cancer recurrence concurrent with silicone breast implant rupture 17 years after mastectomy and immediate implant-based reconstruction in a 53-year-old woman: a case report.

BACKGROUND: Late locoregional breast cancer recurrence and silicone implant rupture can produce similar cutaneous and periprosthetic abnormalities. However, positron emission tomography-computed tomography (PET/CT) may mask the true malignant tumor due to implant-related inflammation, resulting in false-negative results. Cases where breast cancer recurrence and silicone implant rupture coexist have rarely been reported. We report histologically confirmed recurrence with silicone implant rupture 17 years after mastectomy and immediate implant-based reconstruction for ductal carcinoma in situ (DCIS). CASE DESCRIPTION: A 53-year-old woman presented a 4-month history of progressive peri-areolar skin lesions 17 years after right mastectomy and immediate implant-based reconstruction. The lesions initially appeared in the medial peri-areolar region and subsequently extended toward the nipple, with erythema, ulceration, and crusting. Ultrasonography demonstrated skin and subcutaneous oedema, increased vascularity, multiple hypoechoic periprosthetic lesions, and implant capsule discontinuity. PET/CT showed mildly increased peri-areolar uptake [maximum standardized uptake value (SUVmax), 5.2] but no discrete hypermetabolic mass or regional nodal involvement; the findings were interpreted as implant rupture-related inflammation. No pre-operative biopsy or magnetic resonance imaging (MRI) was performed. The patient underwent excision of the nipple-areolar complex (NAC) and involved peri-areolar skin, partial capsulectomy, and implant removal. Intraoperative frozen section confirmed malignancy; implant rupture was identified after capsulotomy. Final histopathological examination revealed a 3.4 cm × 2.5 cm × 2.0 cm, histologic grade 2 invasive ductal carcinoma with multifocal epidermal and subdermal invasion, Paget disease of the nipple, and carcinoma involving the fibrous capsule wall. The tumour was estrogen receptor (ER) positive, progesterone receptor (PR) negative, human epidermal growth factor receptor 2 (HER2) negative by fluorescence in situ hybridization, and had a Ki-67 index of 10%. All peri-areolar lesions represented malignant infiltration, with no silicone granuloma identified. Postoperative treatment would comprise four cycles of anthracycline-taxane chemotherapy, locoregional radiotherapy, and long-term endocrine therapy. The wound healed without complication until the last follow-up in May 2026. CONCLUSIONS: In implant-reconstructed breasts, late-onset skin changes, capsular abnormalities, or new periprosthetic masses warrant timely tissue diagnosis, even when PET/CT does not demonstrate a discrete malignant focus or suggests implant-related inflammation. Imaging findings alone may not reliably distinguish implant rupture-associated changes from locoregional breast cancer recurrence.