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Pleural Damage During Capsulectomy and Exchange of Long-standing Breast Implants in Poland Syndrome: A Cautionary Tale

Gascoigne, Adam C. MBBA(Melb),*†; Malata, Charles M. FRCS(Plast)‡§

doi: 10.1097/SAP.0b013e318226b4c4
Breast Surgery

We present 3 patients undergoing revisional implant surgery more than 20 years after congenital breast asymmetry correction. All of them had Poland syndrome. In 2 patients, the parietal pleura was inadvertently damaged during capsulectomy, resulting in a pneumothorax in one patient and implant loss in the other. The loss followed a copious accumulation of fluid around the implant, possibly due to a (persistent) communication with the pleural cavity. In the first case the pneumothorax was successfully treated intraoperatively. The third patient suffered no complications during surgery. Predisposing factors for pleural damage during revisional implant surgery for congenital breast asymmetry are discussed, in addition to the merits of total capsulectomy during implant exchange. It is concluded that surgeons should aim to minimize the possibility of pleural damage during this surgery and should proceed with caution when performing total capsulectomy in at-risk patients.

From the *Clinical School of Medicine, University of Cambridge, Cambridge, United Kingdom, †University of Melbourne, Melbourne, Australia; and ‡Department of Plastic and Reconstructive Surgery, and §Cambridge Breast Unit Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom.

Received August 9, 2010, and accepted for publication, after revision, May 27, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Charles M. Malata, FRCS(Plast), Department of Plastic and Reconstructive Surgery, Box 186, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, United Kingdom. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.