Neurosurgical transection of the breast: an unexpected extracranial complication of ventriculoperitoneal shunt insertion

Abstract

<jats:p>Ventriculoperitoneal (VP) shunt placement is among the most common surgical procedures undertaken by neurosurgeons. Complications arising from the thoracic portion of the shunt are relatively rare in comparison with those of the intraventricular and peritoneal portions. Disruption of primary breast development following VP shunt placement has not previously been reported. The authors describe the case of a 15-year-old girl referred to the plastic surgery department with a significant right breast deformity and associated asymmetry following VP shunt placement performed during the neonatal period. The calcified shunt was excised and the breast deformity was corrected surgically through multiple scar tissue releases and restoration of the normal breast parenchymal anatomy via a minimally invasive approach, resulting in an excellent aesthetic outcome.</jats:p><jats:p>This case highlights the potential for injury to occult breast tissue in pediatric patients undergoing VP shunt placement, which can impair subsequent cosmesis and quality of life.</jats:p>

Treatment Strategies of Complications of Breast Implants Associated With Ventriculoperitoneal Shunts

“…Literature review returned 34 articles, one of which described two separate patients, bringing cases to a total of 35 breast-related VPS complications (Table 1). 4–37 Seventeen included migration and coiling of the distal catheter inside the breast. Of these 17 patients, 13 had breast implants at the time of migration.…”

“…4 Normally, catheters are tunneled blindly with a long trocar through the subcutaneous tissue of the chest wall, sometimes underneath the breast. 27 This technique, therefore, carries the risk of injuring breast implants 18,21,27 or breast tissue itself (e.g., violation of the inframammary fold 14 or injury to developing parenchyma 28,37 ). To avoid this, we recommend tunneling the catheter medial to the breast along the sternum with plastic surgery colleagues observing intraoperatively, if possible.…”