Effect of right anterolateral thoracotomy on breast development and scoliosis

Abstract

We read with great interest the article “The Influence of Right Anterolateral Thoracotomy in Prepubescent Female Patients on Late Breast Development and on the Incidence of Scoliosis” by Bleiziffer and associates.1Bleiziffer S. Schreiber C. Burgkart R. Regenfelder F. Kostolny M. Libera P. et al.The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis.J. 2004; 127: 1474-1480Google Scholar We agree with the authors that the right anterolateral thoracotomy should be abandoned in prepubescent female patients. In fact, we have been using a limited posterior thoracotomy incision for correction of simple congenital heart defects since 1998, and we have also published our data previously.2Shivaprakasha K. Murthy K.S. Coelho R. Agarwal R. Rao S.G. Planche C. et al.Role of limited posterior thoracotomy for open heart surgery in the current era.Ann Thorac Surg. 1999; 68: 2310-2313Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Earlier studies in young women have also shown that classic anterior and anterolateral thoracotomy incisions lead to unequal breast development.3Cherup L.L. Siewers R.D. Futrell J.W. Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children.Ann Thorac Surg. 1986; 41: 492-497Abstract Full Text PDF PubMed Scopus (117) Google Scholar Just to update our recent data, we analyzed 35 patients who underwent right posterior thoracotomy from February to October 2004 at our institution. Thirty-one underwent operation for secundum atrial septal defect, 2 for ventricular septal defect closure, and 1 each for repair of tetralogy of Fallot (not requiring transannular patch) and partial atrioventricular canal defect. Ages ranged from 3 to 28 years (mean, 13 ± 4 years). A standard right posterior thoracotomy incision was made with the anterior limit up to the posterior axillary line. Cardiopulmonary bypass was instituted by using aortic and bicaval cannulation, and intracardiac repair was performed under fibrillatory or cardioplegic arrest per the surgeons’ choice. All patients survived the operation and were extubated within 12 hours after surgery. The mean stay in the intensive care unit was 24 ± 6 hours. None had phrenic nerve palsy or excessive blood loss. In the postoperative period, there was no short-term limitation of movement of the upper limb. All patients except 2 were discharged on the eighth postoperative day. One had significant residual shunt and had to undergo reoperation through a median sternotomy, and another had a persistent air leak that stopped after 5 days. There was no wound infection. We believe that right posterior thoracotomy is safe and reproducible and does not require sophisticated equipment. It gives a good scar, which is invisible from the front and is masked by typically worn apparel. It does not interfere with future development and modeling of the breast. Reply to the EditorThe Journal of Thoracic and Cardiovascular SurgeryVol. 129Issue 6PreviewWe appreciate the comments of Murala and colleagues on our study “The Influence of Right Anterolateral Thoracotomy in Prepubescent Female Patients on Late Breast Development and on the Incidence of Scoliosis.”1 The correspondents describe a right posterolateral thoracotomy for the repair of atrial septal defect, ventricular septal defect, and tetralogy of Fallot to avoid impaired breast development after an anterior incision. Full-Text PDF