Coombs Demetrius M, Wu Shannon S, Bernard Steven, Djohan Risal, Isakov Raymond, Schwarz Graham, Bassiri Gharb Bahar, Rampazzo Antonio
From the Department of Plastic Surgery, The Cleveland Clinic.
Ann Plast Surg. 2022 Sep 1;89(3):267-273. doi: 10.1097/SAP.0000000000003213. Epub 2022 May 28.
Outcomes related to preexisting breast implants after cardiothoracic procedures are poorly characterized. This study evaluated complications after minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP) in patients with preexisting breast implants.
A retrospective review of patients with prior breast implants who underwent MICS, MS, or EP from 1994 to 2019 was performed. Demographic, treatment, and outcome characteristics were recorded. χ 2 Test and analysis of variance were used to perform statistical comparisons.
In total, 78 patients (37 MICS, 21 MS, and 20 EP) were identified. Mean breast implant age was 13.3, 11.7, and 10.2 years, respectively ( P = 0.235). Intraoperative plastic surgeon involvement was present in 26 (70.3%) MICS cases, compared with 2 (9.5%) MS and 0% EP ( P < 0.001). Intraoperative rupture occurred in 5 (13.5%) MICS cases and no MS or EP cases ( P < 0.001). Postoperative implant complications occurred in 6 (16.2%) MICS, 8 (38.1%) MS, and 5 (25.0%) EP ( P = 0.350) cases, with median time to complication of 5.9, 5.4, and 38.9 months, respectively ( P = 0.596). Revision surgery was performed in 5 (13.5%) MICS, 7 (33.3%) MS, and 5 (25.0%) EP ( P = 0.246) cases. On multivariate analysis, lack of intraoperative plastic surgeon involvement ( P = 0.034) and breast implant age ( P = 0.001) were significant predictors of postoperative complications.
Long-term complication rates are highest among patients with breast implants undergoing MS. Plastic surgeon involvement was significantly associated with fewer postoperative complications. Our results support a multidisciplinary approach to managing breast implants during cardiothoracic procedures.
心胸外科手术后与既往存在的乳房植入物相关的结果特征尚不明确。本研究评估了既往有乳房植入物的患者在接受微创心脏手术（MICS）、正中开胸手术（MS）和电生理手术（EP）后的并发症情况。
对1994年至2019年期间接受MICS、MS或EP的既往有乳房植入物的患者进行回顾性研究。记录人口统计学、治疗和结果特征。采用χ²检验和方差分析进行统计学比较。
共纳入78例患者（37例MICS、21例MS和20例EP）。乳房植入物的平均使用年限分别为13.3年、11.7年和10.2年（P = 0.235）。26例（70.3%）MICS病例术中由整形外科医生参与，而MS病例为2例（9.5%），EP病例为0%（P < 0.001）。5例（13.5%）MICS病例术中发生破裂，MS和EP病例均未发生（P < 0.001）。术后植入物并发症在MICS病例中发生6例（16.2%），MS病例中发生8例（38.1%），EP病例中发生5例（25.0%）（P = 0.350），并发症发生的中位时间分别为5.9个月、5.4个月和38.9个月（P = 0.596）。5例（13.5%）MICS、7例（33.3%）MS和5例（25.0%）EP（P = 0.246）病例进行了翻修手术。多因素分析显示，术中缺乏整形外科医生参与（P = 0.034）和乳房植入物使用年限（P = 0.001）是术后并发症的重要预测因素。
接受MS的乳房植入物患者长期并发症发生率最高。整形外科医生参与与较少的术后并发症显著相关。我们的结果支持在心胸外科手术期间采用多学科方法管理乳房植入物。
