BSV04 Fifteen years later: a rare case of breast filler migration to the vulva

Abstract

Distal migration of breast filler is incredibly rare, with vulval migration being exceptionally uncommon; only five cases have been reported globally. We report the case of a 42-year-old woman with delayed breast filler migration 15 years after injections. She presented with a 4-day history of fevers, abdominal and labial swelling, pain, and sterile discharge from a previous vulvar biopsy site. She had a preceding 6-month history of unexplained progressive bilateral labial swelling. Her past medical history included fibromyalgia and inframammary breast augmentation with an unknown injectable filler 15 years earlier. Notably, she sustained blunt right-sided chest trauma 3 years prior to presenting. Admission blood tests showed C-reactive protein 410 mg L−1, white cell count 13.2 × 109 cells L−1, and procalcitonin 0.54 ng mL−1. Extensive infectious, autoimmune and inflammatory screens were negative, including blood cultures, sexually transmitted infection testing, viral serology, immunoglobulin studies, faecal calprotectin and filaria testing. Computed tomography (CT) imaging demonstrated subcutaneous collections tracking from the vulva along the anterior abdominal wall to the chest wall. A positron emission tomography–CT scan revealed intensely avid collections involving both breasts and the anterior abdominal wall, vulva, proximal thigh and inguinal canal. She underwent incision and drainage of the left labia; biopsies were negative for organisms and acid-fast bacilli. Vulval biopsy showed a dense histiocytic reaction with basophilic exogenous material and foreign-body giant cells consistent with exogenous filler. Our findings support the final diagnosis of delayed distal migration of breast filler triggered by chest trauma with a 15-year latency, systemic inflammatory response and multisite involvement. Multi­disciplinary teamwork with breast surgery, plastics, gynaecology, general surgery, rheumatology and infectious disease was crucial. We highlight a significant challenge in diagnosis and management, requiring a coordinated multidisciplinary effort. We ­reinforce the importance of thorough history taking in dermatology, with particular consideration of prior cosmetic procedures.