Breast Seroma? Where a Shunt Shouldn't Be
Breast augmentation is one of the most commonly performed cosmetic procedure in the US. As these patients age or develop comorbidities, surgeons across many other disciplines will inevitably encounter these patients in their own practices. Consequently, surgeons must be aware of the potential interactions between breast implants and devices commonly used in their fields. Our case describes a woman who suffered one such interaction: migration and coiling of a ventriculoperitoneal (VP) shunt around her breast implant. Recognition of potential complications related to implants and other cosmetic procedures will aid surgeons in appropriate operative planning to prevent these adverse events.
Breast augmentation is one of the most commonly performed cosmetic procedure in the US, with over 300,000 performed in 2017 – a 41% increase from 20001. As its popularity has risen, surgeons across many other disciplines have encountered breast implants during procedures such as thoracotomy2, ICD placement3, and ventriculoperitoneal (VP) shunt placement4. VP shunts, one of the most common neurosurgical procedures, are fraught with complications, such as obstruction, infection, and migration5. In this report, we describe an interaction between a breast implant and a VP shunt. Our case contributes to a growing body of literature highlighting an uncommon, but increasingly important, complication of both VP shunts and breast implants.
A 32 year old female with remote history of breast augmentation with saline implants developed hydrocephalus secondary to metastatic melanoma, for which she underwent a VP shunt placement. Postop imaging confirmed appropriate position of the distal catheter in the abdomen. Six weeks postoperatively, CT chest for monitoring of her lung metastases showed interval retraction of the catheter. It now terminated within the left breast implant capsule, coiled around the implant, which appeared to be surrounded by fluid, thought to be a CSF pseudocyst. Shunt series confirmed malposition of the catheter. Physical exam, further imaging, and workup were negative for shunt malfunction, so elective shunt revision was scheduled for the following week. Breast exam was negative for asymmetry or signs of infection; however, due to concerns for contamination or damage to the implant, the plastic surgeon recommended a capsular washout and implant exchange at time of revision.