Case Report Breast
Silicone Breast Implants Can Save Lives Heather Rosen, MD, MPH Mark Brzezienski, MD Kent Kihyet Higdon, MD
Summary: The authors present a case in which a patient sustained 2 shotgun wounds at close range, resulting in a ruptured silicone breast implant and no other injuries. (Plast Reconstr Surg Glob Open 2014;2:e169; doi: 10.1097/GOX.0000000000000065; Published online 16 June 2014.)
T
here is a paucity of peer-reviewed literature on ballistic injuries in female patients with breast implants. According to the Centers for Disease Control, in 2012, the rate of non-fatal firearm injuries in women in the United States was 4.93 per 100,000, while the rate of fatal firearm injuries in women in the United States was 2.75 per 100,000.1 We found 2 related articles (both of which were letters to the editor) in peer-reviewed literature, one from 1994, describing 2 gunshot wounds resulting in the rupture of a silicone breast implant, which was removed, and the pocket was irrigated and drained, and the implant was not replaced.2 The second article described rupture of a polyurethane-coated silicone implant due to a gunshot wound to the chest, which was treated by removal of the implant, irrigation, and replacement at the same operation.3 To date, there are no reports of patients with breast implants having sustained shotgun injuries. We present the first case of this type of injury.
Fig. 1. Chest radiograph.
CASE
A 59-year-old woman was transported to the emergency room after having been shot twice in the right chest with a shotgun through a door. She had many wounds present on the right upper chest, axilla, shoulder, thoracoabdominal area, and right lower extremity consistent with birdshot. She was awake and stable with normal vital signs upon presentation From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn. Received for publication January 6, 2014; accepted January 17, 2014. Copyright © 2014 The Authors. Published by Lippincott Williams & Wilkins on behalf of The American Society of Plastic Surgeons. PRS Global Open is a publication of the American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. DOI: 10.1097/GOX.0000000000000065
Fig. 2. Computed tomography axial image 1.
Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Department of Plastic Surgery at Vanderbilt University Medical Center.
www.PRSGO.com
1
PRS GO • 2014
Fig. 3. Computed tomography axial image 2.
to the emergency room and complained of pain. Her surgical history was significant for bilateral augmentation mammaplasty with silicone gel implants within the last year. An upright chest x-ray (Fig. 1) and computed tomography scan (Figs. 2–4) of the chest, abdomen, and pelvis were performed. No free air or fractures were noted on the chest x-ray. She had several pellets located within the right breast implant, no evidence of pneumothorax, and several pellets overlying the pericardium and sternum. She underwent a pericardial window by the trauma surgery service, which was negative, and she was discharged from the hospital the following morning. The patient followed up as an outpatient with her surgeon, and underwent removal and replacement of the implants. The right implant contained many shotgun pellets (Fig. 5).
Fig. 5. Photograph of silicone gel implant containing shotgun pellets.
LITERATURE REVIEW
A literature review was performed, and there are 2 case reports in peer-reviewed journals relating to breast implant rupture via gunshot wound. Both involved pistols that fire single bullets. In both cases, as in ours, the patient survived with no damage to the thoracic organs.
CONCLUSIONS
We present the only case in the peer-reviewed literature of a patient who sustained 2 shotgun wounds to the right chest, which resulted in right breast implant rupture and no other injuries. We submit that in her case, as possible in the other 2 cases, where it not for the silicone gel implant, the outcome may have been penetration of the thoracic cavity by the ballistic fragments with subsequent injury to the thoracic structures. Kent Kihyet Higdon, MD Department of Plastic Surgery Vanderbilt University Medical Center 1161 21st Avenue South D-4207 MCN Nashville TN 37232 E-mail: [email protected]
REFERENCES
Fig. 4. A computed tomography sagittal image is displayed.
2
1. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System. http:// www.cdc.gov/injury/wisqars/facts.html 2. Pramod NK, Thoma A. Breast implant rupture due to gunshot injury. Plast Reconstr Surg. 1994;94:893–894. 3. Pereira LH, Sterodimas A. Rupture of high-cohesive silicone implant after gunshot injury. Ann Plast Surg. 2007;58:228–229.
Silicone Breast Implants Can Save Lives Heather Rosen, MD, MPH Mark Brzezienski, MD Kent Kihyet Higdon, MD
Summary: The authors present a case in which a patient sustained 2 shotgun wounds at close range, resulting in a ruptured silicone breast implant and no other injuries. (Plast Reconstr Surg Glob Open 2014;2:e169; doi: 10.1097/GOX.0000000000000065; Published online 16 June 2014.)
T
here is a paucity of peer-reviewed literature on ballistic injuries in female patients with breast implants. According to the Centers for Disease Control, in 2012, the rate of non-fatal firearm injuries in women in the United States was 4.93 per 100,000, while the rate of fatal firearm injuries in women in the United States was 2.75 per 100,000.1 We found 2 related articles (both of which were letters to the editor) in peer-reviewed literature, one from 1994, describing 2 gunshot wounds resulting in the rupture of a silicone breast implant, which was removed, and the pocket was irrigated and drained, and the implant was not replaced.2 The second article described rupture of a polyurethane-coated silicone implant due to a gunshot wound to the chest, which was treated by removal of the implant, irrigation, and replacement at the same operation.3 To date, there are no reports of patients with breast implants having sustained shotgun injuries. We present the first case of this type of injury.
Fig. 1. Chest radiograph.
CASE
A 59-year-old woman was transported to the emergency room after having been shot twice in the right chest with a shotgun through a door. She had many wounds present on the right upper chest, axilla, shoulder, thoracoabdominal area, and right lower extremity consistent with birdshot. She was awake and stable with normal vital signs upon presentation From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn. Received for publication January 6, 2014; accepted January 17, 2014. Copyright © 2014 The Authors. Published by Lippincott Williams & Wilkins on behalf of The American Society of Plastic Surgeons. PRS Global Open is a publication of the American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. DOI: 10.1097/GOX.0000000000000065
Fig. 2. Computed tomography axial image 1.
Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Department of Plastic Surgery at Vanderbilt University Medical Center.
www.PRSGO.com
1
PRS GO • 2014
Fig. 3. Computed tomography axial image 2.
to the emergency room and complained of pain. Her surgical history was significant for bilateral augmentation mammaplasty with silicone gel implants within the last year. An upright chest x-ray (Fig. 1) and computed tomography scan (Figs. 2–4) of the chest, abdomen, and pelvis were performed. No free air or fractures were noted on the chest x-ray. She had several pellets located within the right breast implant, no evidence of pneumothorax, and several pellets overlying the pericardium and sternum. She underwent a pericardial window by the trauma surgery service, which was negative, and she was discharged from the hospital the following morning. The patient followed up as an outpatient with her surgeon, and underwent removal and replacement of the implants. The right implant contained many shotgun pellets (Fig. 5).
Fig. 5. Photograph of silicone gel implant containing shotgun pellets.
LITERATURE REVIEW
A literature review was performed, and there are 2 case reports in peer-reviewed journals relating to breast implant rupture via gunshot wound. Both involved pistols that fire single bullets. In both cases, as in ours, the patient survived with no damage to the thoracic organs.
CONCLUSIONS
We present the only case in the peer-reviewed literature of a patient who sustained 2 shotgun wounds to the right chest, which resulted in right breast implant rupture and no other injuries. We submit that in her case, as possible in the other 2 cases, where it not for the silicone gel implant, the outcome may have been penetration of the thoracic cavity by the ballistic fragments with subsequent injury to the thoracic structures. Kent Kihyet Higdon, MD Department of Plastic Surgery Vanderbilt University Medical Center 1161 21st Avenue South D-4207 MCN Nashville TN 37232 E-mail: [email protected]
REFERENCES
Fig. 4. A computed tomography sagittal image is displayed.
2
1. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System. http:// www.cdc.gov/injury/wisqars/facts.html 2. Pramod NK, Thoma A. Breast implant rupture due to gunshot injury. Plast Reconstr Surg. 1994;94:893–894. 3. Pereira LH, Sterodimas A. Rupture of high-cohesive silicone implant after gunshot injury. Ann Plast Surg. 2007;58:228–229.
