title: Pleural damage during capsulectomy and exchange of long-standing breast implants in Poland syndrome: a cautionary tale.
abstract: 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.
authors.affiliation: Clinical School of Medicine, University of Cambridge, and Department of Plastic and Reconstructive Surgery, Cambridge Breast Unit Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Gascoigne
authors.forename: Charles M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000601:surgery*; D007431:Intraoperative Complications / Q000175:diagnosis; D008875:Middle Aged; D010994:Pleura / Q000293:injuries*; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology*; D011045:Poland Syndrome / Q000601:surgery*; D012086:Reoperation