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Atrophic Annular Plaques on the Breasts Following Augmentation Surgery

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A white woman in her 50s without significant medical history underwent breast augmentation surgery with saline implants without postoperative complications. Five years later, she underwent a bilateral augmentation mammoplasty with removal and replacement of silicone gel implants and major mastopexy with capsulotomy. Although the patient’s surgical course was uncomplicated, several months postoperatively she noted persistent asymptomatic rough areas that she assumed were scars. Seven years after the second surgery, she was referred to dermatology for improvement of the areas for cosmetic reasons.

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B. Annular atrophic lichen planus

A skin biopsy taken from the rim of the left breast lesion showed focal epidermal atrophy, marked hypergranulosis with reactive keratinocytes, and an interface lichenoid reaction (Figure 2A). The upper dermis in the skin biopsy revealed a partial bandlike lymphoid infiltrate and numerous melanin-laden macrophages (Figure 2B). A periodic acid–Schiff with diastase (DPAS) test result was negative for fungi, and an elastic von Gieson stain showed preserved dermal elastic fibers. In view of the clinical presentation and atrophic lichenoid reaction, the skin biopsy specimens were classified as consistent with annular atrophic lichen planus (AALP).

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Article Information

Corresponding Author: Jessica G. Labadie, MD, Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Ste 1600, Chicago, IL 60611 (jessica.labadie@northwestern.edu).

Published Online: August 28, 2019. doi:10.1001/jamadermatol.2019.2245

Conflict of Interest Disclosures: Dr Conrad reported nonfinancial support from Allergan Medical Institute. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information. We sincerely thank Joan Guitart, MD, for his clinical expertise and assistance in the histological analysis and diagnosis of this case. Dr Guitart received no compensation for his assistance.

References
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