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Breast Implant-Related Outcomes after Cardiothoracic Surgeries and Electrophysiologic Procedures
Shannon S. Wu BA, Demetrius M. Coombs MD, Risal Djohan MD, Graham Schwarz MD, Bahar Bassiri Gharb, MD PhD, Antonio Rampazzo, MD PhD
The Cleveland Clinic
2021-02-14
Presenter: Demetrius Coombs, MD
Affidavit:
Yes
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE:
Long-term consequences in patients with pre-existing breast implants following cardiothoracic (CTS) procedures are poorly defined. The purpose of this study was to evaluate complications following minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP).
METHODS:
Single-center, retrospective review of patients with prior breast implants who underwent the aforementioned procedures from 1994-2019.
RESULTS:
Seventy-eight patients met inclusion criteria. Mean age of breast implant was 13.3, 11.7, and 10.2 years (p=0.235). MICS was primarily for valve repair (81.1%); MS for mediastinal pathology (52.4%) and valvulopathy (47.6%); all EP for pacemaker/defibrillator placement (p<0.01). Plastic surgeon involvement was present in 26 (70.3%) of MICS, compared with 2 (9.5%) of MS and 0% of EP (p<0.001). Intraoperative rupture occurred in only 5 (13.5%) MICS cases (p<0.001). Postoperative breast implant complications occurred in 8 (21.6%), 8 (38.1%), and 5 (25.0%) of MICS, MS, and EP (p=0.624). Median time to complication was 5.9, 5.4, and 38.9 months (p=0.596). Revision surgery rates were similar between groups (p=0.081). Median follow-up time was 0.2, 1.0, and 2.5 years for MICS, MS, and EP (p=0.019). On multivariate logistic regression analysis, intraoperative plastic surgeon involvement was negatively correlated with postoperative complications (p=0.034), while increasing age of breast implant was positively correlated with postoperative complications (p=0.001).
CONCLUSION:
Long-term breast implant complication rates are highest following median sternotomy. Plastic surgeon involvement was significantly associated with fewer postoperative complications. The present data supports a multidisciplinary approach to managing breast implants during cardiothoracic procedures. Strategies to facilitate collaboration are provided.
