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• W2323701734 abstract "Sir: We read with great interest the article entitled “Rib Fractures: A Complication of Radiation Therapy and Tissue Expansion for Breast Reconstruction” by Tseng et al.1 We compliment the authors on their work. We totally agree with the recommendation that plastic surgeons counsel patients requesting tissue expanders in an irradiated field about the possibility of rib fracture and subsequent need to alter reconstructive plans. We report a case of two rib fractures subsequent to a breast reconstruction tissue expansion. A 45-year-old woman was admitted for a skin expansion postmastectomy. A 500-cc tissue expander was implanted in the submuscular plane. We inflated 50 cc of saline solution every week for 4 months. A total of 600 cc on each side was inflated. After 1 month, following a sneeze, the patient reported sudden onset of chest pain under her left breast tissue expander. We removed 100 cc of saline solution from the left skin expander, which resulted in improvement of the symptoms. After 3 months, at periodic scintigraphic control, the appearance of a “hot-spot” was observed on the costal left bone (Fig. 1). A chest computed tomographic scan confirmed the presence of left fourth and fifth rib fractures and a moth-eaten appearance to the surrounding left ribs, consistent with postirradiation skeletal changes (Fig. 2).Fig. 1.: Postoperative scintigraphic control showing appearance of a hot-spot on the costal left bone.Fig. 2.: Chest computed tomographic scans showing presence of left fourth and fifth rib fractures and a moth-eaten appearance to the surrounding left ribs.After 2 months, the skin expander was replaced with a 450 mammary implant. No complication followed the operation. At 2-year follow-up, the outcome was satisfactory to the patient. We agree with the authors that caution should be used in skin expansion in postirradiation patients, who are predisposed to a rib fracture more than nonirradiated patients. We would argue for a slow skin expansion in postirradiation patients to avoid rib fracture. In particular, it is important to not overexpand the implant because of the high risk of rib fracture in these patients.2 We think that appropriate and well-performed planning in addition to a consent form is appropriate in irradiated patients before reconstructive surgery with skin expansion. Lucio Tirone, M.D. Ivan La Rusca, M.D. Feliciano Ciccarelli, M.D. Plastic Surgery Unit Villa dei Fiori Hospital Naples, Italy" @default.
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• W2323701734 date "2010-12-01" @default.
• W2323701734 modified "2023-09-25" @default.
• W2323701734 title "Rib Fracture as a Complication of Tissue Expansion in Breast Reconstruction" @default.
• W2323701734 cites W2021216133 @default.
• W2323701734 doi "https://doi.org/10.1097/prs.0b013e3181f61b56" @default.
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