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“Vanishing” breast implant – when a breast prosthesis is moving into the pleural cavity

Published on: 4th August, 2021

OCLC Number/Unique Identifier: 9186946574

This case shown here represents a rare situation where the breast implant is spontaneously and inadvertently migrated from its submammary position via the thoracic wall into the ipsilateral pleural cavity after performing an ipsilateral thoracotomy due to atypical wedge resection of the right upper lobe four months ago. Intraoperatively, the implant has been neither dislodged nor manipulated in any way. In the literature, there are some sparse case descriptions where such breast implant migrations are encountered after VATS procedure (video-assisted thoracoscopy) [2] and open thoracotomy surgery [3]. Interestingly, our case report is quite similar to those which was published by Dutch colleagues in 2014 [4]. Considering the etiology and pathomechanism of such an implant migration as shown here, there is a common agreement that both a leakage of the implant´s fibrous capsule and an operative transection of the intercostal thoracic wall are prerequisite to create a potential migrating pathway to allow implants moving towards the pleural cavity [5]. Additionally, it is believed that the negative pressure within the pleural cavity also alleviates the unidirectional herniation by “sucking in the implant” into the interpleural space [6]. Sometimes, external repetitive pressures such as stretching massages may cause or trigger such an implant dislocation. Furthermore, there are cases described in which, seemingly, implant migration does occur without known preceding thoracic surgery [7]. Eventually, there are cases published in the literature with intrapleural spreading of disrupted breast implant debris [8]. With our patient, thanks to the absence of any discomfort or pain, it was concluded after agreed statement of an interdisciplinary round table discussion not to remove the dislocated implant surgically because of potential intercostal tissue damage and subsequent pain to await. More astonishing, the clinicians involved in this case wondered the fact that the missed implant of her right breast remained either unnoticed or has been completely neglected by the female patient. In this short communication, we present a rare and unusual case of an obviously vanishing breast implant which is found to be inadvertently migrated into the adjacent pleural space after undergoing thoracic surgery. According to common legal policy at our institution, an approval for case reports is generally provided as it was obtained in this particular case.
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