Intrathoracic Migration of a Silicone Breast Implant After Video-Assisted Thoracoscopic Surgery

Intrathoracic migration of a breast implant seven years after thoracotomy. A case report

A 52-year-old woman, who had previous bilateral subpectoral breast augmentation, underwent thoracotomy for a right upper lobe pulmonary adenocarcinoma. Seven years after her thoracic surgery, the patient noticed a reduction in her right breast volume, with shortness of breath and cough. A computed tomography study of the chest revealed intrathoracic migration of her right breast implant with no sing of capsule rupture. Subsequent video-assisted thoracoscopy confirmed this diagnosis.

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Thoracotomy should be performed if possible, in lower intercostal space in patients with breast implants.

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An extensive fibrous capsular formation around the breast implant is not be expected after breast augmentation surgery.

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Radiation therapy can lead to slow going wound healig disorder.

Breast Implant-Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures

BACKGROUND

Outcomes related to preexisting breast implants after cardiothoracic procedures are poorly characterized. This study evaluated complications after minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP) in patients with preexisting breast implants.

METHODS

A retrospective review of patients with prior breast implants who underwent MICS, MS, or EP from 1994 to 2019 was performed. Demographic, treatment, and outcome characteristics were recorded. χ2 Test and analysis of variance were used to perform statistical comparisons.

RESULTS

In total, 78 patients (37 MICS, 21 MS, and 20 EP) were identified. Mean breast implant age was 13.3, 11.7, and 10.2 years, respectively (P = 0.235). Intraoperative plastic surgeon involvement was present in 26 (70.3%) MICS cases, compared with 2 (9.5%) MS and 0% EP (P < 0.001). Intraoperative rupture occurred in 5 (13.5%) MICS cases and no MS or EP cases (P < 0.001). Postoperative implant complications occurred in 6 (16.2%) MICS, 8 (38.1%) MS, and 5 (25.0%) EP (P = 0.350) cases, with median time to complication of 5.9, 5.4, and 38.9 months, respectively (P = 0.596). Revision surgery was performed in 5 (13.5%) MICS, 7 (33.3%) MS, and 5 (25.0%) EP (P = 0.246) cases. On multivariate analysis, lack of intraoperative plastic surgeon involvement (P = 0.034) and breast implant age (P = 0.001) were significant predictors of postoperative complications.

CONCLUSIONS

Long-term complication rates are highest among patients with breast implants undergoing MS. Plastic surgeon involvement was significantly associated with fewer postoperative complications. Our results support a multidisciplinary approach to managing breast implants during cardiothoracic procedures.

Thoracic migration of silicone gel after breast implant rupture: a case report and literature review

Nowadays silicone is a widespread material for medical devices. In particular, it is commonly used for implants manufacturing, for that patients undergoing breast augmentation or breast reconstruction after mastectomy. However, the use of silicone implants is not free from risks. Ruptures of silicone breast implants are uncommon, in general post-traumatic or iatrogenic, and usually related to implant’s wall weakness of unknown origin but probably due to biochemical reactions that cause wall rupture. As a consequence of a rupture, silicone gel from damaged implants may have a continuity migration to the chest wall, axillae, and upper extremities, resulting in granulomatous inflammation or siliconoma, or a lymphatic migration to axillary lymph nodes. In this regard, silicone thoracic migration is extremely rare, and nowadays a leakage is unlikely to happen with more modern cohesive silicone gel implants. Nevertheless, procedures such as thoracic surgery and thoracotomies may be responsible for accidental breast implant rupture, capsular discontinuity, and eventually intrathoracic silicone migration, especially when dealing with older generations of breast implants. We report a rare case of a 75-year-old woman presenting with pleural silicone effusion, 18 years after a right breast reconstruction for breast cancer, followed by right upper lobe resection for a lung carcinoma. A combination of muscular flap and DTI pre-pectoral breast reconstruction with biological membrane (ADM) has been used for treatment. Literature was reviewed for cases of breast implants free silicone localization in the chest cavity, focusing on previous surgeries, anamnestic relevances, and surgical management.

Level of Evidence: Level V, risk/prognostic study.

[Migration of an epicardial pacemaker into the abdominal cavity]

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.