In a case report that appeared in the December 15th issue of the New England Journal of Medicine, a women ‘swallowed’ her breast implant during a pilates exercise. The news media was quick to pick up and publicize this finding, sometimes in a sensational manner. On the surface, this breast implant story does sound bizarre and it undoubtably will raise some concerning questions on either those women considering getting breast augmentation or to those who already have them.
This rare and perhaps never seen before breast implant complication did not occur in a typical breast augmentation patient. This was a 59 year-old woman who had breast cancer and undergone a double mastectomy procedure with implant reconstruction and radiation. Recently, she had surgery to repair the mitral valve in her heart which involves going through the muscle tissue in between her ribs. During a pilates routinue after her recovery, she was doing a Valsalva manuever and it was then that her breast implant disappeared. At the hospital it was discovered that the breast implant had migrated inward through the ribs into the space around the lung. Surprisingly, she was reported to have no chest pain or shortness of breath. The implant was retrieved and repositioned without any problems.
How this happened was due to a perfect scenario that involved the creation of a weak spot on an otherwise usually very stout chest wall. Her heart surgery created a surgical opening in her, which while usually will heal back to normal, was unable to do due to her history of radiation. In breast reconstruction, the implant is commonly placed beneath the pectoralis muscle and on top of the rib cage. Thus, the implant was positioned right over a ‘trap door’ in the chest wall. When doing a Valsalva manuever, which increases the pressure in your chest considerably, one can see how a breast implant could be forced through a very weakened area in the rib and inward towards the lungs from the contraction of the overlying pectoralis muscle.
While one could call this being ‘swallowed’, this is more of a sensationalized term. Rather it is an implant being pushed rather then being actively sucked inward. As one can tell from listening to the actual details of the story, this is not something that any typical breast augmentation needs to be concerned about. It required a confluence of factors coming together, radiation damaged ribs, the perfectly size implant (small) and an existing weak area in the rib cage…and a very specific breathing manuever that coincidently capitalized on it.
Breast augmentation patients should rest assured that they can undergo any strenuous exercise, pilates or otherwise, without fear of having the same thing happen to their implants.
Dr. Barry Eppley
Indianapolis, Indiana