Our Summary

This research paper discusses a rare but increasing complication in patients who have had both breast augmentation and ventriculoperitoneal shunt surgery. A ventriculoperitoneal shunt is a medical device that relieves pressure on the brain caused by fluid accumulation, which is a condition known as hydrocephalus.

The complication arises when a part of the shunt, called the distal catheter, moves from its original position in the abdomen and ends up coiled around the breast implant. This can cause one breast to appear larger due to the formation of a pseudocyst, which is a pocket of cerebrospinal fluid that has collected around the migrated catheter.

The researchers reviewed 17 studies on this issue and also presented their findings from three patients they treated who had this complication. They found that the migration of the catheter occurred between 2 weeks and 9 months after the shunt was placed.

All patients required additional surgery to correct the issue. The methods of surgical treatment varied, including repositioning the catheter, removing it altogether, or placing it into the pleural space (area around the lungs).

The researchers conclude that it is crucial for neurosurgeons to be aware of a patient’s prior breast implant surgery before placing a ventriculoperitoneal shunt. They also suggest that a protocol should be developed to handle these situations to prevent infection and future catheter migration.

FAQs

  1. What is the complication that can occur in patients who have had both breast augmentation and ventriculoperitoneal shunt surgery?
  2. How soon after the shunt placement can the migration of the catheter occur?
  3. What are the possible surgical treatments for this complication?

Doctor’s Tip

A doctor might advise a patient considering breast augmentation to inform their neurosurgeon about any past or future ventriculoperitoneal shunt surgeries. This can help prevent complications like catheter migration and ensure proper treatment if needed. It is important for patients to communicate openly with all of their healthcare providers to ensure the best possible outcomes for their health and well-being.

Suitable For

Patients who are typically recommended for breast augmentation surgery are those who are dissatisfied with the size, shape, or symmetry of their breasts. This can include individuals who have naturally small breasts, have experienced changes in breast size and shape due to pregnancy or weight loss, or have asymmetrical breasts. Additionally, breast augmentation may be recommended for patients who have undergone mastectomy for breast cancer and wish to reconstruct their breasts.

It is important for patients considering breast augmentation to have realistic expectations about the outcomes of the surgery and to be in good overall health. Patients should also have a thorough consultation with their plastic surgeon to discuss their goals, the different types of implants available, and the potential risks and complications associated with the procedure.

Overall, breast augmentation is a personal decision that should be made in consultation with a qualified plastic surgeon based on individual goals and medical history.

Timeline

Before breast augmentation:

  1. Consultation: The patient meets with a plastic surgeon to discuss their goals, options, and potential risks of breast augmentation surgery.
  2. Pre-operative preparation: The patient undergoes pre-operative testing, receives instructions on how to prepare for surgery, and may need to stop taking certain medications.
  3. Surgery: The breast augmentation procedure is performed, either using implants or fat transfer techniques.
  4. Recovery: The patient experiences swelling, bruising, and discomfort in the days and weeks following surgery.

After breast augmentation:

  1. Follow-up appointments: The patient attends follow-up appointments with their surgeon to monitor healing and address any concerns.
  2. Healing process: The patient continues to heal, with swelling gradually decreasing and scars fading over time.
  3. Adjusting to new breasts: The patient may need time to adjust to their new breast size and shape, as well as any changes in sensation.
  4. Long-term care: The patient may need to schedule regular check-ups and consider future surgeries for implant maintenance or replacement.

What to Ask Your Doctor

Some questions a patient should ask their doctor about breast augmentation include:

  1. What are the risks and complications associated with breast augmentation surgery?
  2. How long is the recovery period, and what can I expect during the recovery process?
  3. What type of implants are available, and what are the differences between saline and silicone implants?
  4. How long do breast implants typically last, and will I need to have them replaced in the future?
  5. Are there any specific recommendations or precautions I should follow after the surgery to ensure the best results?
  6. How will breast implants affect mammograms and breast cancer screenings?
  7. What is the likelihood of developing capsular contracture, and how is it treated?
  8. How will breast implants affect breastfeeding, if applicable?
  9. What should I do if I experience any complications or changes in my breasts after the surgery?
  10. Are there any specific considerations or precautions I should be aware of if I have or plan to have a ventriculoperitoneal shunt surgery in the future?

Reference

Authors: Siddiqui S, Miller M, Dumont A, Delashaw J, Wang A. Journal: World Neurosurg. 2024 Jan;181:e743-e751. doi: 10.1016/j.wneu.2023.10.120. Epub 2023 Oct 28. PMID: 37898269