A Subglandular Breast Cerebrospinal Fluid Pseudocyst Following Postsurgical Shunt Migration

Abstract

Summary:Cerebrospinal fluid (CSF) drainage catheters have been associated with numerous complications in various anatomic locations, because of migration, infection, and obstruction. However, breast-related CSF shunt complications tend to occur infrequently or have seldom been reported in the empirical literature. Therefore, a case is presented detailing a breast pseudocyst caused by migration and subsequent coiling of a ventriculoperitoneal shunt in the right breast pocket. To the best of the authors’ knowledge, this is the first case that has been reported in the peer-reviewed literature of a pseudocyst resulting from a CSF drainage catheter coiling around the breast implant post pancreaticoduodenectomy. Moreover, this case highlights the importance of cross-disciplinary procedural awareness, particularly in regards to breast, ventriculoperitoneal shunt, and pancreatic procedures.

Treatment Strategies of Complications of Breast Implants Associated With Ventriculoperitoneal Shunts

“…5 In this report, we describe an interaction between a breast implant and a VPS. Our case contributes to a growing body of literature highlighting an uncommon, but increasingly important, complication of concurrent VPS and breast implantsin fact, this marks the second case encountered by our own department after Mlynek et al 6 described the first in 2015. A systematic literature review was conducted to characterize the range of breast-related VPS complications and generate an algorithm for the plastic surgical team's management of cerebrospinal fluid (CSF) pseudocysts of the breast.…”

“…Literature review returned 34 articles, one of which described two separate patients, bringing cases to a total of 35 breast-related VPS complications (Table 1). 4–37 Seventeen included migration and coiling of the distal catheter inside the breast. Of these 17 patients, 13 had breast implants at the time of migration.…”

“… 21 In addition to the breast, distal catheters have migrated to the lateral ventricles, scalp, oral cavity, pulmonary artery, lung parenchyma, bronchial tree, heart, neck, chest wall, diaphragm, umbilicus, abdominal wall, intestines, gallbladder, vagina, scrotum, and anus 4,5,8,13,17,19,38,39 . A myriad of hypotheses have been proposed to explain catheter migration and coiling, including vigorous manipulation of the breast, traction on the catheter by the breast implant capsule, 21 increased intraabdominal pressure (from cough, strain, exercise, constipation, or abdominal pseudocyst), 4 a calcified part of the catheter acting as an anchoring point to the abdominal wall, vigorous rotation or flexion-extension movements of the head, and retained memory of the shunt material for its coiled shape in its original packaging 6,38 . Breast implant rotation likely contributes to the wrapping of the catheter around the implant itself.…”

Ventriculoperitoneal shunt catheter migration in a patient with breast implants resulting in a peri-implant cerebrospinal fluid pseudocyst

“…In reported cases of migration in patients with breast augmentation, the breast implant remained intact. Proposed mechanisms include sexual activity as an instigating factor [15] , postoperative migration following abdominal surgery [16] , and increased intra-abdominal pressure [17] . While we were unable to visualize or confirm the process of migration in our patient, we can postulate that some sort of inciting factor such as abdominal trauma or strenuous activity may have caused displacement of the catheter and subsequent shunt dysfunction.…”

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

“…We reviewed 14 cases in which the VPS distal catheter migrated into the breast, with only two cases involving intact breasts and 12 involved augmented ones. Catheter migration to the breast could be attributed to many factors such as increased intra‐abdominal pressure, brisk or even violent head movements, and the elastic memory of the catheter (Mlynek et al, ). Furthermore, inadvertent piercing of the implant by the catheter during shunt installation could facilitate this type of migration.…”