CASE REPORT Gauzoma Mimicking Siliconoma After Breast Augmentation Surgery Manuel Sarrabayrouse Horacio F. Mayer Hugo D. Loustau Received: 16 March 2008 / Accepted: 21 April 2008 / Published online: 21 May 2008 Ó Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2008 Abstract Gauzoma is a rare iatrogenic mass caused by the retention of gauze fibers during surgery. This intraop- erative complication represents a diagnostic problem for radiologists besides being a medicolegal problem for sur- geons. We present a patient in whom a retained surgical sponge after breast augmentation surgery mimicked a sil- iconoma and discuss imaging appearance and differential diagnosis. Keywords Gauzoma Á Gossypiboma Á Textiloma Á Muslinoma Á Siliconoma Á Breast augmentation Gauzoma (gossypiboma, textiloma, or muslinoma) is a rare iatrogenic mass caused by the retention of gauze fibers during surgery. This intraoperative complication represents a diagnostic problem for radiologists besides being a medicolegal problem for surgeons. We present a patient in whom a retained surgical sponge (RSS) after breast aug- mentation surgery mimicked a siliconoma. Case Report A 31-year-old female patient who had undergone an augmentation mammaplasty one year before by another surgeon came for consultation because of the presence of a mass in the inferior lateral quadrant of her right breast. This mass did not produce distortion in breast shape and was only detected by means of palpation, which revealed a subcutaneous hard tissue compatible with a siliconoma. No other signs of silicone migration such as nodes along fibers of the pectoralis major muscle or lymph nodes in the axilla were detected. The patient had undergone a subpectoral breast augmentation through a periareolar incision with a torpid postoperative course with more swelling and pain in the right breast. Although no traumatic episode was recognized by the patient and because of the clinical suspicion of implant rupture, a breast ultrasonography was indicated. This study showed the presence of a hypoechoic image adjacent to the implant with acoustic shadows suggest- ing, according to the radiologist, an implant rupture (Fig. 1). In view of these nonconclusive ultrasonic find- ings, a magnetic resonance imaging (MRI) examination was recommended, which showed the presence of a low- signal structure with peripheral enhancement of a thick- walled capsule on T1-weighted images after injection of contrast material (Fig. 2). The mass had a density similar to the silicone implant. Although the mammary implant seemed to be whole, MRI findings were interpreted and informed by the radiologist as implant rupture and sili- conoma. Consequently, the patient underwent an operation to remove the presumed siliconoma and to replace the implant. The pocket was opened and a total capsulectomy was performed, removing the intact implant. Then the mass, covered by a fibrotic capsule, was removed and opened, revealing the presence of a RSS (Fig. 3). Both breast implants were replaced during the same surgical procedure. The patient, discharged on the next day, went on to have a highly satisfactory aesthetic result and no complications. M. Sarrabayrouse (&) Á H. F. Mayer Á H. D. Loustau Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, School of Medicine, Gascon 450, Buenos Aires 1181, Argentina e-mail: manuel.sarrabayrouse@hospitalitaliano.org.ar 123 Aesth Plast Surg (2008) 32:692–694 DOI 10.1007/s00266-008-9174-2