Intrathoracic migration of a breast implant after minimally invasive cardiac surgery.

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.

Endoscopic transumbilical subglandular augmentation mammaplasty.

This technique has provoked many controversial comments. With modification and adequate clinician training and experience, however, the results can improve, and complications can be minimized. The author's complications occurred in the early stages of the use of this method; as experience was gained, they decreased. Furthermore, fewer and less severe complications occurred when the techniques were modified, including using instrument dissection before tissue expansion, better patient selection, early massage, and more frequent postoperative follow-up visits. In addition, this method leaves no scar at the breast and allows a quicker recovery. Most patients who underwent this procedure have been pleased with their results. Transumbilical endoscopic bilateral augmentation mammaplasty is an attractive alternative technique, and with careful patient selection, operative modification, and technical expertise, results can be achieved comparable with an open subglandular augmentation.