The New England Journal of MedicineIntrathoracic Migration of a Breast Implant

Chest Wall Defect Following Cancer Treatment May Lead to Rare Intrathoracic Breast Implant Migration

A case report details an unusual complication of breast reconstruction following cancer treatment. A 73-year-old woman experienced sudden displacement of her right breast implant into the pleural space during pulmonary function testing. This rare occurrence highlights the potential long-term consequences of multiple thoracic surgeries and the importance of careful follow-up in patients with a history of both breast and lung cancer.

Key Points:

• Patient profile: 73-year-old woman with history of breast cancer and non-small-cell lung cancer
• Surgical history: Double mastectomy with breast reconstruction 23 years prior, silicone implants inserted 12 years later
• Lung surgery: Superior segmentectomy of right lower lung via open thoracotomy 3 years before presentation
• Presenting symptom: 1-year history of cough
• Precipitating event: Sudden displacement of right breast implant during pulmonary function testing
• Initial CT findings: Focal herniation of right breast implant (one month prior to displacement)
• Subsequent CT findings: Complete displacement of right breast implant into lower pleural space
• Diagnosis: Intrathoracic migration of breast implant
• Treatment: Right thoracotomy for implant removal and chest wall defect reconstruction
• Additional procedure: Removal of left breast implant
• Outcome: Patient recovered well, with resolution of cough
• Etiology of cough: Attributed to lung herniation through chest wall defect

Rates of breast reconstruction after mastectomy have increased since the passage of the Women’s Health and Cancer Rights Act in 1998, which mandates insurance coverage for all stages of postmastectomy reconstruction.

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