Recurrent Breast Cerebrospinal Fluid Pseudocyst

Abstract

Ventriculoperitoneal (VP) shunt complications involving the breast are rare, with the majority involving the formation of a cerebrospinal fluid pseudocyst. We present the case of a 22-year-old woman with recurrent cerebrospinal fluid pseudocyst secondary to fracture of a VP shunt at the time of breast surgery for breast asymmetry. We review the literature on this topic and present our case that highlights the need of the breast surgeon to take into account the position of VP shunts placed at birth. Shunts placed on the chest wall may result in breast asymmetry requiring surgery in the adolescent. Shunts in place since birth may be at greater risk of fracture during breast implant placement due to manipulation of a calcified and fragile shunt leading to formation of a cerebrospinal fluid pseudocyst.

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.…”