title: Right inframammary mini-thoracotomy approach to the mitral valve in women with breast implants.
abstract: OBJECTIVE
  : Minimally invasive cardiac surgery in patients with breast implants is challenging. Obtaining access to cardiac structures without injuring the prosthesis and at the same time maintaining cosmesis is of particular concern in these patients. Mitral valve surgery can be performed using a right mini-inframammary thoracotomy in female patients with breast implants. We describe our experience with this approach to preserve the cosmetic results of previous breast augmentation.
  
  
  METHODS
  : Six female patients with previous breast implantation presented for isolated mitral valve surgery for degenerative disease. Surgery was performed through an inframammary incision, in most cases using the previous surgical incision from breast implantation. Peripheral cannulation was used for cardiopulmonary bypass. The breast prosthesis was explanted through a 6-cm skin incision, and then the mitral valve was approached through a right mini anterior thoracotomy. At the end of mitral surgery, the implant was replaced.
  
  
  RESULTS
  : All patients had satisfactory outcomes. The mitral valve was repaired in five patients and replaced in one patient. Average length of stay was 5.3 days (range, 4-8 days). There were no conversions to median sternotomy. There were no bleeding complications. There were no wound complications or implant infections. Cosmesis was preserved.
  
  
  CONCLUSIONS
  : Our experience with this approach has allowed both mitral valve repair and replacement at the same time preserving cosmetic results. This minimally invasive technique may also have applications in performing atrial septal defect closure, Maze procedures for atrial fibrillation, and tricuspid valve surgery in patients with breast implants.
authors.affiliation: From the *Department of Thoracic and Cardiovascular Surgery and †Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH USA.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Shafii
authors.forename: Jang Wen
authors.initials: JW
authors.lastname: Su
authors.forename: Mark
authors.initials: M
authors.lastname: Hendrickson
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov