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Background: Calf implants have been around for over forty years in various forms and shapes. The calf implants we know today are composed of a soft solid silicone material which is designed and manufactured with high quality medical grade technology. Such contemporary silicone materials are not known to undergo significant degradation and/or release degradation byproducts.

But silicone materials used in the early development of aesthetic body implants did not have the benefits of the biomaterials technology that is available today. While it is very rare to ever see some of the original efforts at body augmentation plastic surgery the following case report illustrates the incredible tissue tolerance for unknown silicone materials placed near fifty years ago.

Case Study: This older male presented with an enlarged hardened mass of the right calf that had considerable cellulitis. He had a congenital history of a right calf that was much smaller than his left calf. When he was younger he had plastic surgery that consisted of the placement of a first stage tissue expander in the right calf followed by the placement of a solid silicone implant material. He lives with it forever thirty-five (35) years  and never had a problem until recently.

In surgery the original incision in the popliteal crease of the back of the right knee was opened. Upon entering the implant pocket a large amount of thick white fluid was encountered and suctioned out. A hard dark yellow implant was removed which was coated in this thick ‘paint-like’ material. It remains unknown what this more liquid material was but the value of it in the implant pocket was considerable.

The overlying calf skin was very thin with a calcified capsule on its underside. This was only partially removed due to concerns about skin viability. The incision was closed over a drain. The incision went on to heal and the calf skin survived. When seen years later the calf skin had some expected pigmentary changes and skin stiffness, and the calf size was smaller than the left calf, but the lower leg had normal function.

Case Highlights:

1) First generation efforts at calf augmentation used silicone materials of unknown purity or medical grade quality.

2) Chronic cellulitis can develop years to decades later as a result of byproducts of silicone materials of various purities.

3) Removal of all silicone implant materials, solid or otherwise, including as much of the capsule as possible, is necessary for resolution of the inflammatory reaction and skin survival.

Dr. Barry Eppley

Indianapolis, Indiana

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