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The resection specimens of both breasts showed nodular
amyloid deposits only, with no evidence of cancer or
calcifications [Figure 4]. Multinucleated giant cells were
present within and adjacent to the amyloid deposits.
Focal aggregates of lymphocytes (B and T) and plasma
cells were also found.

The patient opted for a bilateral reconstruction with fat
grafting. Two 470 mL expanders were positioned under
the pectoralis major muscle at the time of mastectomy
and gradually inflated on an outpatient basis.

In three consecutive surgeries the expanders were
gradually deflated and that volume replaced by fat grafts
according to the Coleman technique.

At two years of follow-up, MRI did not show any breast
amyloidosis recurrence [Figure 5]. Figure 5: Magnetic resonance imaging of the breasts at 2 years of
follow-up
The patient is satisfied with the reconstruction. No
significant fat resorption was shown [Figure 6].

She is under follow-up for systemic amyloidosis and did
not show involvement of other organs until now.

DISCUSSION

[5]
Röcken et al. and Charlot et al. reported that breast
[4]
amyloidosis is associated with invasive cancer (ductal or
lobular carcinoma or lymphoma). Other studies [6,7]
showed that comitant malignancies may be absent, as Figure 6: Patient appearance at 2 years of follow-up
happened in our case.
Breast amyloidosis doesn’t have specific clinical or
Although breast amyloidosis is most commonly AL type, radiographic features. In the majority of cases it is not
our patient had a systemic amyloidosis of the AH/AL type. suspected clinically; instead, breast biopsies are usually
done to rule out malignancy.

The pathogenesis of localized breast amyloidosis in the
absence of a concomitant breast lymphoma or plasma
cell dyscrasia is unknown, probably originating from local
plasma cells secreting immunoglobulins. Plasma cell
proliferation by itself is probably not sufficient to trigger
amyloid deposition, and undetermined factors are
needed for amyloid deposition. [5]

Prosthetic breast implantation is one of the world’s most
popular aesthetic surgical operations.

The amyloid fibril proteins deposited in the breast of our
patient were not of epithelial origin. Nevertheless, one
may suggest a reaction link between leakage of silicon
and deposition of amyloid deposits. The role of silicone
gel in relation to connective tissue disease and
amyloidosis has not been proved by current serologic,
immunologic, or epidemiologic test. We found
multinucleated giant cells within or adjacent to amyloid
Figure 4: Resection specimens of the breasts deposits; multinucleated giant cells may represent a
242 Plast Aesthet Res || Volume 3 || July 7, 2016