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. 2017:36:110-115.
doi: 10.1016/j.ijscr.2017.05.023. Epub 2017 May 21.

Chest wall reconstruction following axillary breast augmentation and desmoid tumor resection using capsular flaps and a form-stable silicone implant: A case report, diagnosis and surgical technique

Alexandre Mendonça Munhoz  1 , Ary de Azevedo Marques  2 , José Ribas Milanez  3 , Rolf Gemperli  4
Affiliations

Chest wall reconstruction following axillary breast augmentation and desmoid tumor resection using capsular flaps and a form-stable silicone implant: A case report, diagnosis and surgical technique

Alexandre Mendonça Munhoz et al. Int J Surg Case Rep. 2017.

Abstract

Introduction: Chest desmoid tumors (CDT) are rare lesions characterized by fibroblastic proliferation from the connective tissue. Although CDT have been studied previously, no cases following subfascial transaxillary breast augmentation (TBA) have been described.

Presentation of case: The authors describe a case of CDT in a 28-year-old woman one year after TBA, which presented as a painful and progressive mass in the lower-inner right breast quadrant. MRI showed a soft-tissue tumor (6×3×4cm) that affected the region of the right anterior costal margin, without signs of structural costal invasion. Patient was treated surgically, exposing the right costal-sternal region through an inframammary approach and resecting the CDT. The remaining capsular flap was mobilized into the defect and a form-stable silicone implant was utilized to cover the chest wall defect and achieve an adequate breast contour. The patient is currently in 5th year after chest reconstruction, with satisfactory results. Neither the tumor or the symptoms recurred.

Discussion: CDT is an uncommon evolution following TBA. Although it is a rare disease, thoracic and plastic surgeons must be alert to avoid misdiagnosis. Defect reconstruction is necessary, mobilizing the capsular flaps and replacing the implants in order to obtain a satisfactory outcome.

Conclusion: Knowledge of this rare post-operative evolution is crucial, and early surgical intervention is warranted in order to avoid more aggressive treatment. This case report provides general knowledge of CDT, and may be used as guidance for early diagnosis and treatment.

Keywords: Breast augmentation; Breast reconstruction; Case report; Chest reconstruction; Complication; Desmoid tumor; Form-stable silicone implants; Myocutaneous flap.

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Figures

Fig 1
Fig 1
(A–D) Pre-operative frontal and left oblique views of a 28-year-old patient with hypoplastic breasts (A top left. B top right). Appearance six months after procedure, showing very good outcome. 255 cc Natrelle Style 410 MF implants were used bilaterally (C bottom left. D bottom right).
Fig. 2
Fig. 2
Chest MRI showed a well-defined solid submuscular mass 6.1 cm × 2.4 cm × 5.1 cm in size with low to intermediate signal intensity in T1 imaging and high signal intensity in T2 imaging.
Fig. 3
Fig. 3
(A–D) Intraoperative view of the right breast region. The inframammary approach was planned, near the parasternal region and approximately 0.5 cm above the anticipated new fold (a). Exposure of the right parasternal region was performed. The ressection included the whole tumor and a peripheral margin of 1 cm of healthy tissue (b). Intraoperative view of the DT showing a firm tumor with white pattern (c). The chest wall defect was reconstructed with a larger form-stable texturized silicone implant associated with local advancement of capsular flaps (d).
Fig. 4
Fig. 4
(A–D) Appearance five years after procedure, showing very good outcome and satisfactory chest and breast contour. Bilateral 325-cc Natrelle Style 410 MF implants were used (a–d). Neither CDT nor symptoms recurred.
Fig. 5
Fig. 5
(A–B) Chest MRI 58 months after resection, showing no local recurrence..
See this image and copyright information in PMC

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