Breast Implants and Minimally Invasive Cardiac Surgery

Baker, Regina Y.; Nguyen, T. JoAnna; Hernandez, Angela M.; Wong, Alex K.; Baker, Craig J.; Starnes, Vaughn A.

doi:10.1097/sap.0b013e318221b54b

Cited by 11 publications

(10 citation statements)

References 1 publication

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“…In another case series published in 2011 by Baker et al, 8 5 patients with prior breast implants were reviewed after undergoing different minimally invasive cardiac procedures. The breast implant was removed, allowing access into the chest cavity through the fourth intercostal space.…”

Section: Discussionmentioning

confidence: 99%

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Intrathoracic Migration of a Breast Implant After Minimally Invasive Cardiac Surgery

McClure¹,

Aru²,

Songcharoen³

2015

Annals of Plastic Surgery

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The aging population, in combination with the popularity of breast augmentation with implants, presents surgeons with a growing number of cases involving women undergoing minimally invasive cardiac surgery (MICS) who have breast implants. We present an unusual complication involving the delayed migration of a subpectoral implant into the chest cavity through an iatrogenic defect after a minimally invasive mitral valve repair. This chest wall defect was ultimately repaired with a latissimus dorsi flap. Although MICS has been described in women with breast implants, the documented experience remains limited. Most authors classically recommend explantation of the prosthesis to provide access to the chest wall; however, some have later suggested preserving the implant capsule in situ while performing the cardiac procedure with gentle retraction. From our literature review and experience, we recommend that the posterior capsule should remain intact. If this is not possible, then the chest wall closure should be reinforced with either mesh, soft tissue, or both. Soft tissue options include the conversion from a subpectoral to a subglandular position to use the pectoralis major, or a latissimus dorsi muscle flap. With the increasing number of these cases along with the complexities of minimally invasive procedures, close communication and planning should be undertaken between both cardiothoracic and plastic surgeons when taking care of these patients. Above all, when faced with postoperative complications after MICS, the plastic surgeon must maintain a high index of clinical suspicion and consider the possibility of intrathoracic migration of an implant so that proper workup and planning may be initiated.

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Section: Discussionmentioning

confidence: 99%

“…Although MICS has been described in women with breast implants, the documented experience remains limited. [6][7][8][9][10] Most have found MICS to be safe and effective in women with breast implants, with only a few reported complications. From our literature review and experience, we recommend that the posterior capsule should remain intact.…”

mentioning

confidence: 99%

Intrathoracic Migration of a Breast Implant After Minimally Invasive Cardiac Surgery

McClure¹,

Aru²,

Songcharoen³

2015

Annals of Plastic Surgery

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“…10 Before the present study, the association between incision type for breast implant placement and postoperative complication in the setting of cardiac procedures was reliant on very small patient numbers: a case report by Je et al 10 suggest that circumareolar incisions are preferred over inframammary incisions for MICS eligibility. Baker et al, 15 by contrast, describes a series of 5 patients who successfully underwent MICS despite having a classical inframammary incision. 4 Therefore, there exists a need to determine the characteristics of high-risk breast implant patients presenting for cardiac surgery and related procedures, especially as this patient population increases both in number and age.…”

Section: Discussionmentioning

confidence: 99%

Breast Implant–Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures

Coombs

Bernard

et al. 2022

Ann Plast Surg

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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. χ 2 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.

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“…It can be challenging to perform mitral valve repair through a minithoracotomy on patients with breast implants, since the implants may obstruct the procedure. Baker et al, in their series, had the implants explanted and then reimplanted in all patients. Similarly, Shafii et al also used a similar technique to facilitate exposure to the mitral valve .…”

Section: Discussionmentioning

confidence: 99%

Management for Breast Implants in Patients Undergoing Mitral Valve Surgery Through a Right Minithoracotomy

et al. 2013

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Breast Implants and Minimally Invasive Cardiac Surgery

Abstract: Our series of 5 patients demonstrates that minimally invasive heart surgery performed through an inframammary incision can be safely performed in those with breast implants.

Cited by 11 publications

References 1 publication

Intrathoracic Migration of a Breast Implant After Minimally Invasive Cardiac Surgery

Intrathoracic Migration of a Breast Implant After Minimally Invasive Cardiac Surgery

Breast Implant–Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures

Management for Breast Implants in Patients Undergoing Mitral Valve Surgery Through a Right Minithoracotomy

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