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Pneumothorax as a Complication of Breast Augmentation
Andrea G. Kulinich1, John R. Mark1, John M. Osborn2, Lee L.Q. Pu2 1 University of California Davis School of Medicine, CA 2 University of California Davis Medical Center, Department of Plastic Surgery, CA

Background: Pneumothorax is a complication of breast surgery which was thought to be rare until over 15 years ago when a survey of members of the California Society of Plastic Surgeons (CSPS) was completed. The response rate of the survey was 50%, and the incidence of pneumothorax seemed to be more common than generally appreciated with 1 out 3 surgeons experiencing at least one pneumothorax in their career. To our knowledge, no study has examined the actual incidence of pneumothorax in breast augmentation surgery procedures since the above study was published in the journal of Plastic, Reconstructive Surgery (PRS). (Plast. Reconstr. Surg. 2005; 116: 1122) Objectives: This research repeats and expands on the original study. A survey of CSPS members was completed to determine the incidence of pneumothorax during breast augmentation and identify risk factors. Based on the results of the survey, policies will be proposed to manage this complication.

Methods: An online survey was sent to members of the CSPS in 2020, inquiring about their experience with this complication. In addition, a retrospective chart review was completed, in which breast augmentation procedures performed over a 10-year period by 4 plastic surgeons at the UC Davis Health System were screened for pneumothorax. A search of the PubMed/MEDLINE database for articles including the terms "breast augmentation" OR "breast implants" AND "pneumothorax" generated 33 articles between 2005 and 2020. Finally, data on breast augmentations complicated by pneumothoraces was obtained from the American Association of Accreditation of Ambulatory Surgical Facilities (AAAASF) from the year 2019.

Results: The survey response rate was between 15.7% to 32%. The final response rate and incidence are still being determined. To date, twenty-five members reported a total of 43 pneumothoraces in their career. No local or hypodermic needle injections were used in 37.5% of these patients. In the retrospective chart review of 40 breast augmentation procedures performed at UC Davis Health during the study period, no pneumothoraxes were identified. In the literature search, a total of 8 patients who underwent breast augmentation between 2005 and 2020 experienced pneumothorax as a complication. Seven cases (87.5%) were bilateral pneumothoraces. Two cases (25%) were tension pneumothoraces. AAAASF found an incidence of 0.000031% for pneumothorax as a complication of breast augmentation for 2019.

Conclusion: Pneumothorax remains a rare complication of breast augmentation. Possible risk factors for pneumothorax include pulmonary barotrauma, anatomical variations, anesthesia, and surgical causes. This study's findings confirm the conclusions of the 2005 research that a pneumothorax as a complication of breast surgery is rare but continues to occur and is not necessarily due to negligence. This study found that 2 in 5 members of the CSPS had at least one patient who experienced a pneumothorax during breast augmentation in their career, compared to 1 in 3 from the previous survey. It is still recommended to include pneumothorax as a risk of breast augmentation in the informed consent and that a chest tube set be available to the surgeon if breast augmentation is performed in a free-standing surgery center.

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