A Presentation of Penile Siliconoma in Primary Care after a Dubious Implant Injection: A Case Report

Abstract@#Cases of penile siliconoma are unusual and less commonly present to medical practitioners. The siliconoma is a subsequence of injecting high viscous solution into the penis; commonly sillicone with the aim to enhance its size and performance. This case will look at a patient who developed penile siliconoma after a dubious penile implant injection gone wrong. It will also look at what surgical options are available to the unfortunate patients to ease their suffering. Physician should have a high index of suspicion on the use of such substances to enhance sexual performances in patients presenting with atypical penile swelling.

Acellular Dermal Matrices and Paraffinoma: A Modern Tool for a Nearly Obsolete Disease

Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems.

Late-Onset Complication of Fillers: Paraffinoma of the Lower Eyelids Clinically Mimicking Xanthelasma

Injectable poly-L-lactic acid (PLLA) is world-famous filler used in lipoatrophy and facial rejuvenation because of its collagen neogenesis effect which leads to gradual volume restoration. Until recently, quite a number of unwanted adverse events of PLLA have been reported. However, to the best of our knowledge, paraffinoma as a complication of PLLA has never been reported. We herein describe the first case of paraffinoma after Sculptra® injection and propose its possible mechanism.

Penile paraffinoma: A surgical challenge

OBJECTIVE: The authors share their experience on four different cases of penile paraffinoma surgically treated at the Bicol Medical Center from January 2011 - September 2014. METHODOLOGY: Four patients with subcutaneous injection of foreign body (Vaseline, petroleum jelly or Baby oil) into their penises were treated. The authors applied two kinds of technique: anterolateral thigh pedicle flap and scrotal advancement flap, depending on the skin defect after excision of the paraffinoma. Outcomes measured were immediate post-operative complications (flap necrosis, hematoma, infection) and 3 months post-operative follow-up (contracture, pain on erection, improvement in sexual function and acceptable cosmetic appearance). RESULTS: All patients had a relatively uneventful post-operative course. There were no instances of flap necrosis, bleeding, hematoma or dysuria. Morbidity was minimal and no secondary surgical intervention was done. All had acceptable cosmetic appearance based on the satisfaction of both the patients and the surgeons. All reported decrease in pain during erection, except for one, who underwent scrotal advancement flap, complaining of vague penoscrotal pain when his penis was erect. CONCLUSION: Penile paraffinoma remains a reconstructive surgical challenge requiring application of varying techniques depending on the pre-operative foreign body involvement.

Penile Paraffinoma

Penile augmentation with injection of paraffin is a common practice in South East Asia. Penile paraffinoma occurring due to injection of liquid paraffin to enhance the size of the penis is an uncommon condition. Normally, this procedure is carried out by nonmedical personnel, without the prior knowledge or consultation of any urologist. The occurrence of such a deforming procedure is not commonly known to the medical profession in Malaysia.

A Case of Eyelid Paraffinoma Misdiagnosed as a Chalazion

PURPOSE: Paraffinoma is a granulomatous reaction to paraffin or oily substances. We report delayed diagnosis of paraffinoma that was misdiagnosed as chalazion. CASE SUMMARY: A 49-year-old male presented with masses, swelling, and erythema in the right lower eyelid, masses and swelling in the right upper eyelid, and intermittent conjunctival injection that had appeared 3 months ago. The patient admitted having received paraffin injection to the right lateral canthal area and nasal bridge for cosmetic purposes by non-medical personnel 17 years prior to presentation. The mass showed partial response to intralesional triamcinolone injection but did not respond to systemic steroid. CONCLUSIONS: Paraffinoma can present diagnostic confusion given its protracted latency period and discordance of injection area and mass location. Detailed history taking is required and the possibility of paraffinoma should be considered for mass lesions of the eyelid.

Surgical Treatment of Paraffinomas in Patients with Leprosy / 대한피부과학회지

BACKGROUND: Ulnar nerve palsy leads to thumb-web depression, hypothenar flattening, and inter-digital depression in patients with leprosy. To camouflage these deformities, patients used to inject paraffin or silicone oil into the areas of muscle atrophy associated with thumb-web depression and hypothenar flattening. After several years and decades, paraffinomas eventually resulted in extensive inflammatory fibrosis and recalcitrant recurrent ulcers at the injection sites. OBJECTIVE: The aim of this study is to compare the results of different surgical treatments for paraffinomas in patients with leprosy, and to find out the most effective treatment method that has a low recurrence rate. METHODS: Between January 2000 and December 2012, 47 patients with paraffinomas who had visited the Korean Hansen Welfare Association Hospital were enrolled to participate in the study. The number of paraffinomas was 56, and the mean age of the patients was 73 years. A retrospective evaluation of the cosmetic results and recurrence rate was performed. RESULTS: Of the 56 surgically treated paraffinomas, 30 lesions were treated using primary closure, 20 lesions were treated with skin graft, and 6 lesions were treated with skin flap. The cosmetic outcomes, which were assessed using a four-point grading scale, were excellent in 10.7% (6/56), good in 25% (14/56), fair in 38% (21/56), and poor in 28% (15/56) of the patients. There were no significant differences among the three surgical procedures with respect to the cosmetic results. The recurrence rate was 33% (10/31) in the primary closure group, 50% (10/20) in the skin graft group, and 17% (1/6) in the skin flap group. There were no significant differences in the recurrence rate among the three surgical procedures. CONCLUSION: The extensive and aggressive curettage of lesions is very important to reduce recurrence rate. When the older age of the patients is considered in conjunction with the simplicity of the operation and the total operation time, primary closure is considered the treatment of choice both cosmetically and practically.

Clinical characteristics and Treatment of Paraffinomas in patients with Hansen disease / 나학회지

BACKGROUND: Ulnar nerve palsy in patients with Hansen disease causes hand wasting and atrophy. To masquerade these deformities, patients injected paraffin or silicone into the lesions, which results in paraffinomas. Several years later, painful inflammation, ulceration or abscesses may develop in the paraffinomas. OBJECTIVE: To investigate the clinical characteristics of paraffinomas in patients with Hansen disease, and to evaluate and compare the effects of various surgical treatment methods of paraffinomas. METHODS: Fifty-seven patients with paraffinomas were randomized to receive debridement(curettage) with primary closure, skin graft, skin flap, or second intention at the hospital of Korean Hansen Welfare Association from 1998 to 2012. We analyzed retrospectively the final cosmetic results of three methods, primary closure, skin graft, and skin flap, in 33 patients with more than 6 months follow-up. The final results were classified into 4 grades, excellent, good, fair, and poor. RESULTS: Of 57 patients, the ratio of male and female was 42:15 and the average age was 73 and 71 years repectively. The location of the lesions was the hand and wrist in 54 patients and the face in 3. The total number of procedures was 72 and that of 3 methods was 55. In 33 patients, 19 showed above fair grades and the recurrence rate was 42%(14/33). There were no serious postoperative complications. CONCLUSION: Wide and thorough curettage as debridement was very important to reduce recurrence and the primary closure was most efficient in consideration of an old age of patient, simplicity of procedure and cosmeosis.

One-sheet spiraling full thickness skin graft for penile resurfacing after paraffinoma excision.

In the midst of on-going non-illicit practice of silicone or paraffin injection to enlarge penis, the author reported 3 cases of surgical treatment to resurface the body of the penis after excision of the destructed penile skin using full thickness skin graft. The skin excision was performed technically through penile body degloving procedure. Full thickness skin graft was then applied as a single sheet donor tissue to cover the denuded penile body spirally. The full thickness graft, which is relatively easy to be performed, is no doubt much thinner than a skin flap, while it also bears a smaller degree of secondary contraction than split skin graft. The color of the skin is considerably matched as it comes from the groin, which is a nearby area of penis. The size and skin sensitization of the penis looks to be natural. The only disadvantage is the common possibility of either spiral or circular junctional scar in between graft edges and between the graft and the penile mucosa and skin to develop hypertrophic scar. However, this possible scar problem applies also to any other surgical scar with any donor tissue. Fortunately, the 3 cases posed no scar problem and normal appearance. All the patients have also regained their normal sexual function.

Difficult evaluation of thyroid cancer due to cervical paraffin injection / 대한외과학회지

Paraffinoma is a well known complication of previous paraffin injection into the subcutaneous layer that presents as various conditions including firm mass formation, edema, induration, ulceration, and skin necrosis. Paraffinoma can mimic neoplasm on physical examination and imaging studies and may complicate ultrasonographic diagnoses due to typical posterior shadowing and high echogenicity. When paraffinomas involve around the thyroid gland, the diagnosis of thyroid tumors is very difficult. We present a case of thyroid cancer, the evaluation of which was complicated by the presence of cervical paraffinoma.

Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

Secondary Augmentation Rhinoplasty with Immediate Autogenous Dermofat Graft after Removal of Paraffinoma

PURPOSE: Paraffin has been used to augment depressed nasal contour for many years by illegally. Reported complications of nasal paraffinoma were skin thinning, displacement of nasal profile, redness, chronic inflammation and malignant change to skin cancer. The current authors report results of the secondary rhinoplasty after excision of nasal paraffinoma. METHODS: Through the open rhinoplasty incision, paraffinoma was removed under direct vision. Saline irrigation and meticulous hemostasis were performed. Simultaneously, the secondary depressed nasal deformity was corrected with autogenous dermofat graft harvested from inferior gluteal fold. The dermofat was fixed to the nasofrontal area with bolster suture, and the interdormal area of the tip. RESULTS: A total of 13 patients underwent secondary augmentation with autogenous dermofat graft after removal of paraffinoma from 2000 to 2004. The mean follow-up period was 15 months. There were no postoperative complications. All patients were satisfied with their surgical results. However, there were 10 to 20 percent resorption of the grafted dermofat. CONCLUSION: It is suggest that autogenous dermofat be one of good materials for the correction of the secondary deformity after removal of nasal paraffinoma. In addition, autogenous dermofat graft presented easy harvesting and manipulation for transfer, high survival rate by firm fixation to the recipient site and stable surgical results.

Immediate Breast Reconstruction Using Bilateral Free TRAM Flap after Removal of Paraffinoma

Injection of liquid Paraffin wax was a form of breast augmentation practiced in Korea and many Asian countries for decades. Paraffin makes chorionic foreign body granulomas and brings mass formation, discolorization, deformity of surrounding tissue and in severe cases, necrosis of mammary tissue and skin. Author has experienced 45 year old female with previous bilateral Paraffin injection by unqualified physician. In initial physical examination revealed diffuse, hard and mobile masses in both breasts with overlying skin change, inflammation and discolorization. Mammography showed diffuse, markedly dense breast due to foreign body granulomas on both breasts. Because of skin invasion of the paraffinoma, especially on the breast of right side, modified radical mastectomy was performed rather than skin-sparing mastectomy and reconstructed with bilateral TRAM flap immediately. After 3 month, author reconstructed nipple with MDOT(Modified Double Opposing Tab) Flap, and after 1 year, reconstructed nipple-areola complex with tattooing. This paper represent our experience with bilateral paraffinoma and reconstruction of bilateral TRAM flap after modified radical mastectomy.

One-stage Reconstruction after Partial Removal of Paraffinoma in Face with Dermofat Graft and Face Lift

Paraffin injection for aesthetic purpose by unauthorized people has many problems. One of the most common complication is the paraffinoma. Because of problems after paraffinoma removal, such as flap necrosis and facial nerve injury, the treatment of the choice is only partial removal. But there can be some depression and sagging of the cheek left after paraffinoma removal. So we have treated 8 patients who have suffered from paraffinoma in forehead and cheek by partial removal of paraffinoma and correction of the depression and the sagging of the cheek with dermofat graft and face lift. Through the extended preauricular incision, after skin flap elevation we removed paraffinoma as much as possible. Dermofat graft from the gluteal area was performed at paraffinoma removed site. And we prevented the sagging of the cheek skin by the suspension pull through suture. The follow up period was from 2 to 26 months(mean, 12 months). All the patients were satisfied with the reduction of the paraffinoma and they did not complain any deformity. One patient had flap necrosis on nasal dorsum and postauricular area, but they healed with dressing only in two weeks. We concluded that one-stage reconstruction with dermofat graft and face lift after partial removal of paraffinoma is reliable method in treating of paraffinoma in forehead and cheek.

Breast Paraffinoma Coexisting Breast Cancer / 한국유방암학회지

A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.

Breast Paraffinoma Coexisting Breast Cancer / 한국유방암학회지

A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.

The Treatment of Penile Paraffinoma Using Various Scrotal Flap

Paraffin injection for augmentation of penis is usually attempted by untrained persons. Complications such as penile deformity, skin necrosis, erectile dysfunction, and foreign body sensation usually follow. Definite treatment for the patients with those complications includes complete removal of skin and subcutaneous tissue infiltrated by the paraffin and resurfacing with skin graft and local flap. It may not be possible to remove paraffinoma completely due to infiltrated corpus cavernosum and spongiosum. The remnant paraffinoma does not permit skin graft coverage. For the patients who had these problems, we tried techniques comprised of various scrotal flaps to produce reliable and stable coverage. The scrotal skin, which has high elasticity and good texture, seems to be a good material for denuded penis coverage, despite its hairy nature. Since March 1998, 21 patients with penile paraffinoma have been treated using the various scrotal flaps. All flaps survived and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful with no other major complications.

Resurfacing in Penile Paraffinoma by Groin Flap

Paraffinoma induces many unexpected complications such as tissue necrosis, granuloma formation, hypersensitivity, embolism and even carcinoma. The treatment modality is known to be primary repair, flap surgery, skin graft, radiotherapy and high frequency current treatment after the excision of the lesion. Although these methods can remove the paraffinoma and resurface penile shaft, various complications such as skin tension after surgery, hypertrophic scars, difficulty of erection, and deficiency of bulkiness are frequently occurred. Groin flap is the proper method for the patients who want simultaneously soft tissue reconstruction and augmentation of penis. A 32 year-old male patient who visited our clinic had firm mass, abscess, skin necrosis, and dyspareunia after the injection of paraffin into penis 3 months ago. Reconstruction was executed using right side of the groin flap after the radical resection of the whole tissues ruined by infections and infiltration of paraffin. The penile bulkiness, erectile function and duration of erection was all satisfactory. The follow-up period was 7 months after the surgery and no specific complication was developed. Groin flap is the satisfactory method to enhance penile bulkiness as well as resurface the lesion.

Lipogranuloma in the Upper Lids

The author experienced a case of paraffinoma in a 64-year-old woman who complained of nontender hard masses of both upper lids causing difficulties of eye opening and ptosis and had undergone injection of foreign material into zygomatic areas 20 years ago for cosmesis. Excisional biopsy showed multiple irregular shaped vacuoles with perivacuolar dense fibrotic rim and chronic inflammatory cell infiltration in interstitium. These findings were consistent with lipogranuloma[paraffinoma].