CASE REPORTS BREAST SURGERY Cavernous Hemangioma Between the Elastomer and Fibrous Capsule of a Breast Implant Tatiana Cardoso de Mello Tucunduva 1 • Antonio Gaziero 1 • Vivian Siqueira Tostes 1 • Monica Maria Agata Stiepcich 1 • Ulysses S. Torres 1 • Patricia Ohara 1 • Wesley Pereira Andrade 2 • Adriana Helena Padovan Grassmann Ferreira 1 • Debora Rejtman Missrie 1 • Giselle Guedes Netto de Mello 1 Received: 15 March 2018 / Accepted: 5 May 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018 Abstract Hemangiomas are described in many locations, but breast hemangioma (BH) is rare, accounting for only 0.4% of all breast tumors. These tumors are difficult to diagnose preoperatively using conventional imaging modalities because they lack pathognomonic characteris- tics. Mammographic and sonographic appearances of BH were described in just a few case reports, and breast implant-related hemangiomas are even rarer. We report a case of the tumor arising in an atypical location—between the elastomer and fibrous capsule of a breast implant. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Hemangioma Á Breast Á Implants Á MRI Á Ultrasound Introduction Hemangiomas are infrequent benign vessel tumors in the breast, found incidentally in lumpectomy and mastectomy specimens [1], but sometimes presenting as palpable masses [2]. Breast hemangiomas (BHs) are difficult to diagnose preoperatively using conventional imaging modalities because they lack pathognomonic characteristics. The main differential diagnosis is angiosarcoma that shares some imaging and histological aspects with BH. Because of the aggressive biological behavior and rarity of angiosarcomas, there is divergence about the appropriate management of a hemangioma diagnosed by imaging methods or by core-needle biopsy [3]. We present a case of a hemangioma arising beside a breast implant in a postmenopausal patient with atypical MRI characteristics. Case Report A 64-year-old woman with round textured breast implants (275 cc) inserted 8 years before by dual-plane technique came to our service for breast cancer screening and eval- uation of the prosthesis. By physical examination, no lump was detected, and bilateral capsular contracture (Baker III) associated with breast ptosis was identified. A screening mammogram was performed, without suspicious lesions (BI-RADS Ò 2). MRI was ordered for better evaluation of breast implants and revealed a 2.0-cm hypointense mass at T1- and T2-W sequences (Fig. 1a–c) located between the elastomer and fibrous capsule in the left breast, with rapid and heteroge- neous enhancement on the initial phase and showing washout on delayed phase (Fig. 1d–f). Ultrasound demonstrated a hypere- choic, oval circumscribed mass (Fig. 1g), with internal vascu- larity (Fig. 1h), located between the elastomer and fibrous capsule. A core-needle biopsy (Fig. 1i) revealed vascular pro- liferation with tortuous vessels and organizing internal thrombus, fibrosis and stromal hyalinization of the surrounding par- enchyma. The differential diagnosis comprised hemangioma or low-grade angiosarcoma, and complete excision and evaluation of the lesion was recommended. & Ulysses S. Torres ulysses.torres@grupofleury.com.br 1 Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, Sa ˜o Paulo, SP 01333-910, Brazil 2 Instituto de Oncomastologia, Sa ˜o Paulo, Brazil 123 Aesth Plast Surg https://doi.org/10.1007/s00266-018-1153-7