- Email: [email protected]
Paraffinoma of the male breast: a case report
British Journal of Plastic Surgery (1983) 36, 522-523 0 1983 The Trustees of British Association of Plastic Surgeons
Paraffinoma of the male breast: a case report S. P. J. KAY and M. N. SAAD Plastic Surgery Unit, Wexham Park Hospital, Slough
Summary-A transexual.
case of paraffinoma of the male breast is reported following injections of paraffin in a male
Augmentation of the body contour by localised injection of hard and soft paraffin rose to a zenith of popularity in the early 1900s (Ortiz-Monasterio and Trigos, 1972), whereafter the severe destructive consequences of such injections became widely recognised and their use in the West declined, although reports of such cases have come from the East (Boo-Chai, 1965) and more recently from Central America (Ortiz-Monasterio and Trigos, 1972). We present a patient in whom this procedure had been performed and describe the disastrous consequences.
injections beneath the breast discs. The patient returned to London to find, some 3 months later, that his breasts had become tender and painful. Biopsy at that time apparently showed a paraffinoma. At this stage the skin of the breasts was unaffected and no further treatment was performed. The following year peno-scrotal ablation with vaginoplasty was performed in Britain. Several months later, early in 1982, progressive breast pain, nipple discharge and skin changes led to his referral to our out-patient clinic by his general practitioner. By this time, despite all his previous surgery, he had decided to revert to a male role in society. Physical examination showed a bearded male with all the signs of his past surgery. He had enlarged, indurated, immobile and tender breasts (Figs. 1 and 2). No discharge was noted but the skin was of a diffuse yellow colour, indurated and atrophic with small patches of superficial skin breakdown. No lymph nodes were palpably enlarged and a chest radiograph was unremarkable. At exploration under general anaesthesia, diffuse fibrous and inflammatory tissue was encountered surrounding innumerable loculi of oily clear fluid. NO clear-cut capsule or plane of transition to normal tissue
Case report The patient is a genetic male employed in electronic engineering. In 1977 he had made the decision to assume a female role and had sought private psychiatric treatment in London, during the course of which he received feminising steroids which resulted in slight breast growth. Nonetheless, in 1979, seeking further breast augmentation, he attended a practitioner in Spain who performed a series of three bilateral paraffin
Fig. 1 Figure l-Face
view to show the grotesque
Figure 2-Close-up
Fig. 2 appearance
of each breast following
view of the right breast to show the damage
injection
of paraffin
to the skin and subcutaneous 522
tissues.
in a male transexual
523
PARAFFINOMA OF THE MALE BREAST: A CASE REPORT was seen, and in fact the “abnormal
tissue” extended in all directions well beyond the anatomical boundaries of the breast. Bilateral mastectomy was performed together with excision of the affected skin and the residual defects were grafted with split-skin. Histologically the specimens from both breasts showed multiple irregular cystic spaces lined by foreign body giant cells with intervening areas of foreign body granulomata and scattered collections of foamy histiocytes.
believe that the peculiar motivations and aims of our patient may have made him vulnerable to such charlatan practice. References Boo-Chai, K. (1965). Paraffinoma. Plastic and Reconstructive Surgery, 36, 101. Ortiz-Monasterio, F. and Trigos, 1. (1972). Management of patients with complications from injection of foreign materials into the breasts. Plastic and Reconstructive Surgery, 50, 42.
Discussion of the breast has previously been described in women, but is a rare condition in
The *uthors S. P. J. Kay, FRCS, formerly S.H.O. in Plastic Surgery,
Britain where augmentation with silicone gel-filled prostheses is widely available. This case illustrates the terrible consequences of paraffin injections, although the added complications of nodal “metastasis” and infiltration of the thoracic cavity did not occur. Attention is drawn to the fact that this technique is still practised in Europe and we
Wexham Park Hospital, now Registrar in Plastic Surgery, West Midlands Regional Plastic Surgery Unit, Wordsley
Paraffinoma
Hospital, Stourbridge. M. N. Saad, FRCS. Consultant Plastic Surgeon, Wexham Park Hospital, Slough. Requests for reprints to: Magdy N. Saad, FRCS, 47 Alma Road, Windsor, Berks. SL4 3HH.
Paraffinoma of the male breast: a case report S. P. J. KAY and M. N. SAAD Plastic Surgery Unit, Wexham Park Hospital, Slough
Summary-A transexual.
case of paraffinoma of the male breast is reported following injections of paraffin in a male
Augmentation of the body contour by localised injection of hard and soft paraffin rose to a zenith of popularity in the early 1900s (Ortiz-Monasterio and Trigos, 1972), whereafter the severe destructive consequences of such injections became widely recognised and their use in the West declined, although reports of such cases have come from the East (Boo-Chai, 1965) and more recently from Central America (Ortiz-Monasterio and Trigos, 1972). We present a patient in whom this procedure had been performed and describe the disastrous consequences.
injections beneath the breast discs. The patient returned to London to find, some 3 months later, that his breasts had become tender and painful. Biopsy at that time apparently showed a paraffinoma. At this stage the skin of the breasts was unaffected and no further treatment was performed. The following year peno-scrotal ablation with vaginoplasty was performed in Britain. Several months later, early in 1982, progressive breast pain, nipple discharge and skin changes led to his referral to our out-patient clinic by his general practitioner. By this time, despite all his previous surgery, he had decided to revert to a male role in society. Physical examination showed a bearded male with all the signs of his past surgery. He had enlarged, indurated, immobile and tender breasts (Figs. 1 and 2). No discharge was noted but the skin was of a diffuse yellow colour, indurated and atrophic with small patches of superficial skin breakdown. No lymph nodes were palpably enlarged and a chest radiograph was unremarkable. At exploration under general anaesthesia, diffuse fibrous and inflammatory tissue was encountered surrounding innumerable loculi of oily clear fluid. NO clear-cut capsule or plane of transition to normal tissue
Case report The patient is a genetic male employed in electronic engineering. In 1977 he had made the decision to assume a female role and had sought private psychiatric treatment in London, during the course of which he received feminising steroids which resulted in slight breast growth. Nonetheless, in 1979, seeking further breast augmentation, he attended a practitioner in Spain who performed a series of three bilateral paraffin
Fig. 1 Figure l-Face
view to show the grotesque
Figure 2-Close-up
Fig. 2 appearance
of each breast following
view of the right breast to show the damage
injection
of paraffin
to the skin and subcutaneous 522
tissues.
in a male transexual
523
PARAFFINOMA OF THE MALE BREAST: A CASE REPORT was seen, and in fact the “abnormal
tissue” extended in all directions well beyond the anatomical boundaries of the breast. Bilateral mastectomy was performed together with excision of the affected skin and the residual defects were grafted with split-skin. Histologically the specimens from both breasts showed multiple irregular cystic spaces lined by foreign body giant cells with intervening areas of foreign body granulomata and scattered collections of foamy histiocytes.
believe that the peculiar motivations and aims of our patient may have made him vulnerable to such charlatan practice. References Boo-Chai, K. (1965). Paraffinoma. Plastic and Reconstructive Surgery, 36, 101. Ortiz-Monasterio, F. and Trigos, 1. (1972). Management of patients with complications from injection of foreign materials into the breasts. Plastic and Reconstructive Surgery, 50, 42.
Discussion of the breast has previously been described in women, but is a rare condition in
The *uthors S. P. J. Kay, FRCS, formerly S.H.O. in Plastic Surgery,
Britain where augmentation with silicone gel-filled prostheses is widely available. This case illustrates the terrible consequences of paraffin injections, although the added complications of nodal “metastasis” and infiltration of the thoracic cavity did not occur. Attention is drawn to the fact that this technique is still practised in Europe and we
Wexham Park Hospital, now Registrar in Plastic Surgery, West Midlands Regional Plastic Surgery Unit, Wordsley
Paraffinoma
Hospital, Stourbridge. M. N. Saad, FRCS. Consultant Plastic Surgeon, Wexham Park Hospital, Slough. Requests for reprints to: Magdy N. Saad, FRCS, 47 Alma Road, Windsor, Berks. SL4 3HH.