Imaging |

Intrathoracic Migration of a Breast Implant in a Patient With Cystic Fibrosis FREE TO VIEW

Stephen Doyle, DO; Michael Crosser, MD
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University of Kansas, Kansas City, MO

Chest. 2015;148(4_MeetingAbstracts):521A. doi:10.1378/chest.2242905
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SESSION TITLE: Imaging Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: In 2013, the most common cosmetic procedure was breast augmentation with 290,000 surgeries performed. Complications from this procedure need to be recognized by physicians to promptly coordinate care to prevent dire complications.

CASE PRESENTATION: A 36-year-old female with cystic fibrosis presents with a partial small bowel obstruction. Surgical history included a right upper lobe lobectomy for persistent infiltrates and chronic infections 8 months prior, as well as bilateral breast augmentation without complications 13 years ago. The small bowel obstruction resolved with medical management. On the day of planned discharge, she had an episode of coughing while laughing, and subsequently noticed her right breast implant had disappeared. This had happened intermittently before, but the implant would always return to proper position with a valsalva maneuver. On physical exam, the right implant was no longer visible or able to be palpated, but left implant was in proper location. Thoracic CT revealed migration of the entire right breast implant into the right chest cavity with a small right pleural effusion concerning for implant leak. Plastic and cardiothoracic surgery evaluated the patient and she ultimately underwent a surgical exploration. The implant was found to be intact in the right pleural space. A 5 x 3 cm defect was noted in the thoracic wall where the implant migrated. The defect was closed and patient was advised not to have further breast augmentation.

DISCUSSION: Migration of breast implants into the thoracic cavity is an extremely rare complication. Upon literature review, only seven case reports were found, all of which were reported following thoracic surgery. Our patient represents the only reported case of this complication in the cystic fibrosis population. Cystic fibrosis patients more frequently undergo thoracic surgery for pneumothorax, chronic infection, hemoptysis, or lung transplantation. In addition, they more likely are malnourished, have impaired wound healing, and increased negative intrathoracic pleural pressure. Studies show body image disorders are more prevalent in the cystic fibrosis population, which can predispose these patients to undergo cosmetic procedures more frequently than the general population. These manifestations of cystic fibrosis lead to an increase likelihood of complications from elective procedures.

CONCLUSIONS: Clinicians need to recognize and educate patients about this risk. They also need to implement timely evaluation of the thorax with imaging in patients with previous thoracic surgery, especially if there is no evidence of implant rupture on examination. This can prevent serious, life threatening complications including, but not limited to pneumothorax, pneumonia, empyema, cardiac tamponade, or death.

Reference #1: Havermans, T., K Colpaert, and L J. Dupont. "Quality of life in patients with Cystic Fibrosis: association with anxiety and depression." Journal of cystic fibrosis 7.6 (2008): 581-84.

DISCLOSURE: The following authors have nothing to disclose: Stephen Doyle, Michael Crosser

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