Intrathoracic Migration of a Breast Implant After Minimally Invasive Cardiac Surgery

Abstract

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.

Minimal-Invasive Mitral Valve Repair after Breast Augmentation

“…12 However, intraoperative manipulation of the implant has been associated with several complications such as implant leakage, breast deformity, and secondary implant migration. 9,13, 14 Pervaiz et al reported a successful MIMVS after breast augmentation without explanting the prosthesis. 11 Also, Je et al reported a successful minimal-invasive combined atrium septum defect closure and tricuspid valve reconstruction with capsule preservation of a breast implant.…”

“… 12 However, intraoperative manipulation of the implant has been associated with several complications such as implant leakage, breast deformity, and secondary implant migration. 9 13 14 …”

Minimally Invasive versus Conventional Aortic Root Surgery: Results of an Intermediate-Volume Center

“…12 However, intraoperative manipulation of the implant has been associated with several complications such as implant leakage, breast deformity, and secondary implant migration. 9,13 14 Pervaiz et al reported a successful MIMVS after breast augmentation without explanting the prosthesis. 11 Also, Je et al reported a successful minimal-invasive combined atrium septum defect closure and tricuspid valve reconstruction with capsule preservation of a breast implant.…”

Breast Implant–Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures

“…Currently, few reports in the literature detail the optimal approach to managing women with prior breast implants who present for cardiothoracic (CT) interventions. Case series have been described, highlighting the concern for unintentional breast implant manipulation during CT surgery 4,5 . However, findings are limited to small patient cohorts, heterogeneity between patients and surgical interventions, and lack of statistical power to formulate conclusions about defining optimal clinical practice.…”

“…Case series have been described, highlighting the concern for unintentional breast implant manipulation during CT surgery. 4,5 However, findings are limited to small patient cohorts, heterogeneity between patients and surgical interventions, and lack of statistical power to formulate conclusions about defining optimal clinical practice. There remains a need to determine the safety and complication rates of patients with breast implants who undergo CT interventions.…”