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Incidence of Pneumothorax During Tissue Expander-Implant Reconstruction and Algorithm for Intraoperative Management

Schneider, Lisa F. MD*; Albornoz, Claudia R. MD, MSc*; Huang, James MD; Cordeiro, Peter G. MD*

doi: 10.1097/SAP.0b013e31827e2936
Breast Surgery
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Background Iatrogenic pneumothorax is a serious intraoperative complication of immediate breast reconstruction with tissue expanders. However, there is paucity of literature regarding incidence or management of intraoperative pneumothorax in the breast reconstruction patient population.

Methods We performed a retrospective chart review on prospectively collected data from all patients undergoing immediate breast reconstruction with tissue expanders from 1992 to 2012 to determine institutional incidence. We also searched the Nationwide Inpatient Sample database from 1998 to 2008 to determine national incidence.

Results A total of 9653 tissue expanders were placed in 6955 patients at the Memorial Sloan Kettering Cancer Center between 1992 and 2012. There were 3 cases of pneumothorax during immediate breast reconstruction with tissue expanders. The incidence of pneumothorax is 0.03% per expander and 0.04% per patient. From the national database, there were 153 cases of pneumothorax during immediate breast reconstruction with tissue expanders in 27,612 patients. The overall national incidence of pneumothorax is 0.55% per patient.

Conclusions Our algorithm for management includes a thoracic surgery consultation intraoperatively. A chest tube should be placed at a site distal to the pleurotomy. The site of injury should be repaired primarily or patched as necessary. If the patient remains stable, it is safe to proceed with placement of the tissue expander.

From the *Division of Plastic and Reconstructive Surgery and †Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Received August 3, 2012, and accepted for publication, after revision, November 14, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Peter G. Cordeiro, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 424 East 68th St, New York, NY 10065. E-mail: cordeirp@mskcc.org.

© 2014 by Lippincott Williams & Wilkins