title: Incidence of pneumothorax during tissue expander-implant reconstruction and algorithm for intraoperative management.
abstract: 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.
authors: From the *Division of Plastic and Reconstructive Surgery and †Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Lisa F
authors: LF
authors: Schneider
authors: Claudia R
authors: CR
authors: Albornoz
authors: James
authors: J
authors: Huang
authors: Peter G
authors: PG
authors: Cordeiro
mesh_terms: D000465:Algorithms; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D015625:Tissue Expansion Devices / Q000009:adverse effects*
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