Images in Clinical Medicine
Disappearance of a Breast Prosthesis during Pilates
N Engl J Med 2011; 365:2305December 15, 2011
- Article
A 59-year-old woman with a history of breast cancer who underwent bilateral mastectomy and placement of breast prostheses presented for evaluation, reporting that her “body swallowed one of the implants” during a Pilates stretching exercise. The patient reported no chest pain or dyspnea. She had recently undergone a minimally invasive surgical mitral-valve repair for the treatment of severe mitral regurgitation; the point of entry for the surgery was the preexisting scar from the right mastectomy. During a Valsalva maneuver, a circumscribed area of the patient's right anterior chest ballooned outward (Panel A). Bedside ultrasonography revealed lung herniation through a disrupted intercostal space. Posteroanterior and lateral chest radiographs showed elevation of the right hemidiaphragm (Panel B, asterisks). Computed tomography confirmed the intrathoracic position of the prosthesis within the pleural space (Panel C, arrows). The patient was taken to the operating room, where the intact prosthesis was extracted and repositioned. The unstable intercostal space, created during valvular surgery and through which the prosthesis had migrated, was repaired with mesh.
Tiffany C. Fong, M.D.
Beatrice Hoffmann, M.D., Ph.D.
Johns Hopkins University, Baltimore, MD
