Intrathoracic breast implants for postpneumonectomy syndrome: A systematic review of safety and efficacy.

Abstract

Postpneumonectomy syndrome results from mediastinal shift into an empty hemithorax after pneumonectomy, causing bronchial collapse. Treatment options to restore anatomical positioning include placement of intrathoracic breast implants or tissue expanders. There lacks literature evaluating the efficacy and safety of this intervention or comparing types of implants used. A systematic review was conducted by searching the PubMed and Embase databases. Data regarding sample size, implant type, complications, and operative outcomes were extracted. Outcomes included efficacy and complications occurring with the use of saline and silicone implant and expander, and complications included implant leakage, overfilling/compressive symptoms, postoperative infection, and death. Fifty-nine studies with 163 patients met the inclusion criteria. Symptoms owing to implant overfilling were significantly associated with saline implant use (17.9%, p=0.0024). Content leakage was more common with the use of tissue expanders than fixed-volume implants (15.7%, p=0.04). Complications occurred more frequently with larger implant volumes, with a mean volume of 862.7 cc in patients without reported complications vs. 1268.8 cc in patients with a reported complication (p=0.0001). Overall, placement of intrathoracic prostheses was effective, with 81.6% of patients experiencing at least partial symptom improvement and 67.5% of patients experiencing complete improvement postoperatively. There was no difference between efficacy or failure rates in saline vs. silicone vs. tissue expander prostheses. Saline, silicone, and tissue expander implants may each be used successfully in resolving symptoms caused by mediastinal shift, with reasonable risk profiles. Therefore, selection of material and volume must be tailored to the patient's estimated dead space and anticipated growth potential.