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Direct Injection of Paraffin into the Breast: Mammographic, Sonographic, and MRI Features of Early Complications

Basak Erguvan-Dogan1 and Wei T. Yang1

1 Both authors: Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 135, Houston, TX 77030.


Figure 1
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  		Fig. 1A —33-year-old woman with history of paraffin injection 1 year earlier who presented with pain and lumpiness in both breasts. Right mediolateral oblique mammogram reveals bandlike increased density (white arrows) in retromammary prepectoral space. Also note multiple obscured and circumscribed masses (black arrows) in breast parenchyma and prepectoral region that were better seen on anterior compression views (not shown).

 

Figure 2
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  		Fig. 1B —33-year-old woman with history of paraffin injection 1 year earlier who presented with pain and lumpiness in both breasts. Right breast sonogram shows band of septated complicated fluid collection (arrows) in retromammary area and separate intramammary cystic collection (arrowhead). Pectoralis muscle is compressed and difficult to show.

 

Figure 3
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  		Fig. 1C —33-year-old woman with history of paraffin injection 1 year earlier who presented with pain and lumpiness in both breasts. T1-weighted sagittal MR image (TR/TE, 450/15; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.4 mm) of right breast shows multiple hypointense loculated structures (arrows) in breast parenchyma and dome-shaped fluid (asterisk) in retroglandular region.

 

Figure 4
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  		Fig. 1D —33-year-old woman with history of paraffin injection 1 year earlier who presented with pain and lumpiness in both breasts. T2-weighted sagittal fat-suppressed MR image (2,000/100; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.4 mm) of right breast shows multiple round intermediate- to high-signal-intensity fluid collections (arrows) in superficial breast parenchyma and subareolar region and hyperintense fluid (asterisk) in retroglandular area.

 

Figure 5
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  		Fig. 1E —33-year-old woman with history of paraffin injection 1 year earlier who presented with pain and lumpiness in both breasts. Contrast-enhanced T1-weighted sagittal MR image of right breast with fat suppression (475/15; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.4 mm) shows no enhancement of intramammary and retroglandular fluid.

 

Figure 6
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  		Fig. 2A —35-year-old woman with history of bilateral paraffin injections 3 years earlier presented with palpable abnormality in upper left breast. Left mediolateral oblique mammogram reveals diffuse globular-shaped opacity in central left breast (arrow) that is inseparable from underlying dense breast parenchyma.

 

Figure 7
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  		Fig. 2B —35-year-old woman with history of bilateral paraffin injections 3 years earlier presented with palpable abnormality in upper left breast. Sagittal extended-field-of-view sonogram of left breast shows anechoic retroareolar fluid (straight arrows) with strand seen inferiorly (curved arrow), most likely representing dissected retroglandular fat better identified on MR images. Note breast parenchyma anteriorly (star) and compressed pectoralis posteriorly (asterisk).

 

Figure 8
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  		Fig. 2C —35-year-old woman with history of bilateral paraffin injections 3 years earlier presented with palpable abnormality in upper left breast. T1-weighted sagittal image (TR/TE, 450/15; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.4 mm) of left breast shows hypointense fluid in retroglandular area. Note that dissected retroglandular fat (arrow) is seen as intersecting thin septum of high intensity within fluid.

 

Figure 9
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  		Fig. 2D —35-year-old woman with history of bilateral paraffin injections 3 years earlier presented with palpable abnormality in upper left breast. T2-weighted fat-suppressed sagittal image (2,000/100; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.4 mm) of left breast shows hyperintense retroglandular fluid with low-intensity septum (arrow).

 

Figure 10
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  		Fig. 3A —55-year-old woman with history of paraffin injection 30 years earlier who presented with bilateral hard breast masses. Right mediolateral oblique mammogram shows flocculent dystrophic ring calcifications and retroglandular architectural distortion (arrows).

 

Figure 11
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  		Fig. 3B —55-year-old woman with history of paraffin injection 30 years earlier who presented with bilateral hard breast masses. T2-weighted fat-suppressed sagittal image (TR/TE, 2,000/100; field of view, 30.0 cm; slice thickness, 4.0 mm; interslice gap, 0.5 mm) of right breast shows subglandular region (arrows) to be low intensity relative to breast parenchyma and fat.

 

Figure 12
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  		Fig. 3C —55-year-old woman with history of paraffin injection 30 years earlier who presented with bilateral hard breast masses. T1-weighted contrast-enhanced fat-suppressed image (475/15; slice thickness, 4.0 mm; interslice gap, 0.4 mm; field of view, 35 cm) of right breast shows profound suppression and signal void due to calcifications associated with fibrosis and plaquelike changes in retroglandular region (arrows). T1-weighted nonenhanced sagittal image (not shown) of right breast showed round hypo- to isointense structures in retromammary region.

 

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